The structure of the face and eyes is well suited for protecting the eyes from injury. The eyeball is set into a socket surrounded by a strong, bony ridge. The eyelids can close quickly to form a barrier to foreign objects, and the eye can tolerate a light impact without damage. Even so, injury can damage the eye and its surrounding structures, sometimes so severely that vision is lost, and in rare instances, the eye must be removed.
Most eye injuries are minor, but because of extensive bruising, they often look worse than they are. Any injury to the eye should be examined by an ophthalmologist (eye doctor) to determine whether treatment is needed and whether eyesight may be affected permanently.
Foreign body eye injuries
The most common eye injuries are those to the sclera, cornea, and lining of the eyelids (conjunctiva) caused by foreign objects. Although most of these injuries are minor, some – such as penetration of the cornea or development of an infection from a cut or scratch on the cornea – can be serious.
Causes of surface injuries include glass particles, wind-borne particles, tree branches, and falling debris. Workers in certain occupations tend to have small particles fly in their faces; these workers should wear protective eyewear. Another common source of surface injuries is the contact lens. Poorly fitting lenses, lenses left in the eyes too long, lenses left in while a person sleeps, inadequately sterilised lenses, and forceful or inept removal of lenses can scratch the surface of the eye.
Any injury to the surface of the eye usually causes pain and a feeling that there’s something in the eye. It may also produce a sensitivity to light, redness, bleeding from the surface blood vessels of the eye, or swelling of the eye and eyelid. Vision may become blurred.
A foreign object in the eye must be removed. The ophthalmologist may instil anaesthetic drops to numb the surface of the eye. Using a special lighting instrument to view the surface in detail, he then removes the object. Often the foreign object can be lifted out with a moist sterile cotton swab. Sometimes it can be flushed out with sterile water.
If the foreign object has produced a small, superficial corneal abrasion (scratch), an antibiotic ointment applied for several days may be all the treatment needed. Larger corneal abrasions require additional treatment. Antibiotics are instilled, and a patch is placed over the eye to keep it closed.
Fortunately, the surface cells of the eye regenerate rapidly. Under a patch, even large abrasions tend to heal in 1 to 3 days. If the foreign object has pierced the deeper layers of the eye, the ophthalmologist should be consulted immediately for emergency treatment.
Blunt eye injuries
A blunt impact forces the eye back into its socket, possibly damaging the structures at the surface (the lid, conjunctiva, sclera, cornea, and lens) and those at the back of the eye (retina and nerves). Such an impact may break bones around the eye as well.
In the first 24 hours after an eye injury, blood leaking into the skin around the eye usually produces a bruise (black eye). If a blood vessel on the surface of the eye breaks, the surface will become red. Such bleeding is usually minor.
Damage to the inside of the eye is often more serious than damage to the surface. Bleeding into the front chamber of the eye is potentially serious and requires attention by an eye doctor (ophthalmologist). Recurring bleeding and increased pressure (as a result of the injury) within the eye may lead to blood staining of the cornea, which can reduce vision and increase the life-long risk of glaucoma.
Blood can leak into the inside of the eye, the can be torn, or the lens can become dislocated. Bleeding may occur in the retina, which may become detached from its underlying surface at the back of the eye. Initially, retinal detachment may create images of irregular floating shapes or flashes of light and may make vision blurry, but then vision greatly decreases. In severe injuries, the eyeball can rupture.
Ice packs may help reduce swelling and ease the pain of a black eye. By the second day, warm compresses can help the body absorb the excess blood that has accumulated. If the skin around the eye or on the lid has been cut (lacerated), stitches may be needed. When possible, stitches near the edge of the eyelids should be applied by an eye surgeon to ensure that no deformities develop that will affect the way the lids close. An injury affecting the tear ducts (leading from the eye lids to the back of the throat) should be repaired by an eye surgeon.
For a laceration of the eye, pain medications may be given along with medications to keep the pupil dilated and to prevent infection. A shield is often used to protect the eye from further injury. Serious damage may result in some loss of sight, even after surgical treatment.
Anyone who has internal bleeding in the eye caused by trauma is instructed to rest in bed. Medication to reduce increased eye pressure may be needed. Sometimes additional medication is given to reduce bleeding. Any medication that contains aspirin should be avoided because aspirin can increase internal bleeding in the eye. People taking medication to keep their blood from clotting or aspirin for any reason should tell the doctor immediately. Rarely, recurring bleeding requires surgical drainage by an ophthalmologist.
However, PREVENTION IS BETTER THAN CURE!
Burn eye injuries
Exposure to strong heat or chemicals makes the eyelids close quickly in a reflex reaction to protect the eyes from burns. Thus, only the eyelids may be burned, although extreme heat can also burn the eye itself.
The severity of the injury, the amount of pain, and the appearance of the eyelids depend on the depth of the burn.
Chemical burns can occur when an irritating substance gets into the eye. Even mildly irritating substances can cause substantial pain and damage the eye. Because the pain is so great, there’s a tendency to keep the eyelids closed, thereby keeping the substance against the eye for a prolonged period.
To treat burns on the eyelids, a health care practitioner washes the area with a sterile solution and then applies an antibiotic ointment or a strip of gauze saturated with petroleum jelly. The treated area is covered with sterile dressings.
A chemical burn of the eye is treated by immediately flooding the open eye with water for up to 5 minutes. This treatment must be started even before trained medical personnel arrive. Although a person may have difficulty keeping the injured eye open during this painful treatment, quick removal of the chemical is essential. Severe burns may need to be treated by an ophthalmologist (eye surgeon) to preserve vision and prevent major complications, such as damage to the iris, perforation of the eye, and deformities of the eyelids. However, even with the best treatment, severe chemical burns of the cornea can lead to scarring, perforation of the eye, and blindness.
It is thus vital to take extra care and wear protective equipment when working with exposed chemicals.