Doctor's Notes on Eye Injuries
Eye injuries can be minor, such as getting soap in an eye, to loss of vision or loss of the eye. Eye injuries can occur anywhere - at home, in the workplace, from other accidents, or while participating in sports.
Symptoms of eye injures depend on the type of injury. Symptoms of eye injures due to chemical exposure include pain or intense burning, profuse tearing, eye redness, and swollen eyelids. Symptoms of eye injures due to subconjunctival hemorrhage (bleeding) include a red spot of blood on the sclera (the white part of the eye). Symptoms of eye injures due to corneal abrasions include pain, a sensation that something is in the eye, tearing, and sensitivity to light. Symptoms of eye injures due to iritis include pain, light sensitivity, and excessive tearing. Symptoms of eye injures due to hyphema (bleeding in the eye) include pain and blurred vision. Symptoms of eye injures due to orbital blowout fracture include pain, especially with movement of the eyes; double vision that disappears when one eye is covered; and eyelid swelling which may worsen after nose blowing; numbness of the upper lip on the affected side; and swelling around the eye and bruising (black eye). Symptoms of eye injures due to conjunctival lacerations include pain, redness, and a sensation that something is in the eye. Symptoms of eye injures due to lacerations to the cornea and the sclera include decreased vision and pain. Symptoms of eye injures due to foreign bodies in the eye include a sensation that something is in the eye, tearing, blurred vision, light sensitivity, decreased vision, eye pain, double vision or decreased vision. Symptoms of eye injures due to light-induced injuries include pain, light sensitivity, redness, an intense feeling something is in the eye, and decreased vision with a small area of central blurring.
Eye Injuries Symptoms
- Chemical exposure: The most common symptoms are pain or intense burning. The eye will begin to tear profusely, may become red, and the eyelids may become swollen.
- Subconjunctival hemorrhage (bleeding): Generally, this condition by itself is painless. Vision is not affected. The eye will have a red spot of blood on the sclera (the white part of the eye). This occurs when there is a rupture of a small blood vessel on the surface of the eye. The area of redness may be fairly large, and its appearance is sometimes alarming. Spontaneous subconjunctival hemorrhages may occur in the absence of any known trauma. If it is unassociated with other signs of trauma, it is not dangerous and generally goes away over a period of four to 10 days with no treatment.
- Corneal abrasions: Symptoms include pain, a sensation that something is in the eye, tearing, and sensitivity to light.
- Iritis: Pain and light sensitivity are common. The pain may be described as a deep ache in and around the eye. Sometimes, excessive tearing is seen.
- Hyphema: Pain and blurred vision are the main symptoms.
- Orbital blowout fracture: Symptoms include pain, especially with movement of the eyes; double vision that disappears when one eye is covered; and eyelid swelling which may worsen after nose blowing. Numbness of the upper lip on the affected side may occur. Swelling around the eye and bruising often occur. A black eye is the result of blood pooling in the eyelids. This can take weeks to disappear totally.
- Conjunctival lacerations: Symptoms include pain, redness, and a sensation that something is in the eye.
- Lacerations to the cornea and the sclera: Symptoms include decreased vision and pain.
- Foreign bodies:
- Corneal: A sensation that something is in the eye, tearing, blurred vision, and light sensitivity are all common symptoms. Sometimes the foreign body can be seen on the cornea. If the foreign body is metal, a rust ring or rust stain can occur.
- Intraorbital: Symptoms, such as decreased vision, pain, and double vision, usually develop hours to days after the injury. Sometimes, no symptoms develop.
- Intraocular: People may have eye pain and decreased vision, but initially, if the foreign body is small and was introduced into the eye at high velocity, people may have no symptoms.
- Light-induced injuries:
- Ultraviolet keratitis: Symptoms include pain, light sensitivity, redness, and an intense feeling that something is in the eye. Symptoms do not appear immediately after ultraviolet exposure but rather about four hours later.
- Solar retinopathy: Decreased vision with a small area of central blurring is the primary symptom.
Eye Injuries Causes
- Chemical exposures and burns: A chemical burn can occur in a number of ways but is most often the result of a liquid splashing into the eye. Many chemicals, such as soap, sunscreen, and even tear gas, are merely irritants to the eye and do not usually cause permanent damage. However, strong acids and alkalis are highly caustic and may cause severe and permanent damage to the ocular surface.
- Acids (such as sulfuric acid found in car batteries) or alkaline substances (such as lye found in drain cleaner and ammonia) can splash into the eyes.
- Rubbing the eye when working with chemicals may transfer substances from the skin on the hands to the eye.
- Aerosol exposure is another method of potential chemical injury and includes such substances as Mace, tear gas, pepper spray, or hairspray.
- Subconjunctival hemorrhage (bleeding): This is a collection of blood lying on the surface of the white of the eye (sclera). The sclera is covered by the conjunctiva, which is the transparent blood vessel containing membrane that lies over the sclera. Subconjunctival hemorrhage may accompany any eye injury. It may also be spontaneous. The degree of subconjunctival hemorrhage is not necessarily related to the severity of the injury.
- Corneal abrasions: The cornea is the transparent tissue that is located in front of the pupil and iris. A corneal abrasion is a scratch or a traumatic defect in the surface of the cornea. People with corneal abrasions often report that they were "poked" in the eye by a toy, a metallic object, a toddler's fingernail, or a tree branch or that they wore their contact lens too long.
- Traumatic iritis: This type of injury can occur in the same way as a corneal abrasion but is more often a result of a blunt blow to the eye, such as from a fist, a club, or an air bag in a car. The iris is the colored part of the eye. It contains muscles that control the amount of light that enters the eye through the pupil. Iritis simply means that the iris is inflamed.
- Hyphemas and orbital blowout fractures: These injuries are associated with significant force from a blunt object to the eye and surrounding structures. Examples would be getting hit in the face with a baseball or fist, getting kicked in the face, or being struck in the eye by a racquetball, squash ball, champagne cork, or some similar object.
- Hyphemas are the result of bleeding in the eye that occurs in the front part of the eye, called the anterior chamber. This is the space between the cornea and the iris. The anterior chamber is normally filled with clear fluid, called the aqueous fluid.
- Orbital fractures are breaks of the facial bones surrounding the eye. An orbital blowout fracture is a break in the thin bone that forms the floor of the orbit and supports the eye (orbital floor fracture).
- Lacerations (cuts) to the eyelids or conjunctiva (the clear covering over the white of the eye): These injuries commonly occur from sharp objects but can also occur from a fall.
- Lacerations to the cornea and the sclera: These injuries are potentially very serious and are frequently associated with trauma from sharp objects made of metal or glass.
- Foreign bodies in the eye: Generally, a foreign body is a small piece of metal, wood, or plastic.
- Corneal foreign bodies are embedded in the cornea and, by definition, have not penetrated the eye itself. Iron containing metal foreign bodies in the cornea can cause a rusty stain in the cornea, which also requires treatment.
- Intraorbital foreign bodies are located in the orbit (or eye socket) but have not penetrated the eye.
- Intraocular foreign bodies are injuries in which the outer wall of the eye has been penetrated by the object, which is now lodged within the eye itself.
- Ultraviolet keratitis (or corneal flash burn): The most common light-induced trauma to the eye is ultraviolet keratitis, which can be thought of as a sunburn of the cornea. Common sources of damaging ultraviolet (UV) light are welding arcs, tanning booths, and sunlight reflected by snow, water, or other reflective surfaces, especially at higher altitudes where UV rays are more intense.
- Solar retinopathy: Damage to the central part of the retina can occur by staring at the sun. Common situations that may cause this are viewing solar eclipses or drug-induced states where the person looks at the sun for an extended period of time.
When it comes to signs of eye disease, Americans are blind to the facts. A recent survey showed that while nearly half (47%) of Americans worry more about going blind than losing their memory or their ability to walk or hear, almost 30% of those surveyed admitted to not getting their eyes checked.
The following slides take a look at some of the signs and symptoms of some of the most common eye diseases.
Kasper, D.L., et al., eds. Harrison's Principles of Internal Medicine, 19th Ed. United States: McGraw-Hill Education, 2015.