Burns, wounds to the eyelid, scratches to the eyes and foreign materials in the eyes are just a few examples of eye injuries. Injuries to the eye are not always serious, but it is nevertheless important to always seek medical attention for eye or eyelid injuries. In this way, the patient avoids possible complications with vision. Sometimes certain eye problems occur later. A golden rule is to always transport the patient to the ophthalmologist or hospital in a sitting position.
- Symptoms of eye injuries
- Black eye
- Scratches on the eyes
- Self-care
- Professional medical care
- Metal or iron in the eye
- Eyelid wound
- Self-care
- Professional medical care
- Superficial eye wounds
- Dust in the eye
- Self-care
- Professional medical care
- Burning of the eye
- Chemical combustion
- Heat
- UV beams
- Seek medical attention (ophthalmologist) for eye injuries
- Interview
- Diagnostic research
- Reaction to foreign materials in the eye
- Prognosis of foreign body in the eye
- Complication: Endophthalmitis
- Prevention of eye injuries
Double vision is one of the possible symptoms of eye injuries / Source: Frankieleon, Flickr (CC BY-2.0)
Symptoms of eye injuries
Depending on the type of eye injury, one or more of the following symptoms may be present:
- bruising
- bleeding from or around the eyes
- squinted eyes
- double vision (diplopia)
- a discharge from the eyes (eye discharge)
- sensitivity to light (photophobia)
- the feeling that there is something in the eye (sandy feeling in the eye)
- headache
- itchy eyes
- cramp in the eyelids (medical term: blepharospasm) which makes it impossible to open the eyes and also makes it difficult to assess the injury
- feeling unwell or fainting
- eye pain
- pupils of unequal size (anisocoria)
- red, bloodshot eyes
- tearing eyes
- stabbing, aching or burning eye pain
- complete or partial loss of vision in one eye or both eyes
Black eye
A black eye is usually due to direct trauma to the eye or face. The bruise is caused by bleeding under the skin. The tissue around the eyes turns a black and blue color, which over a few days turns a purple, green and yellow color. The abnormal color disappears within two weeks. Swelling of the eyelid and tissue around the eye also sometimes occurs. With hyphemia, bleeding occurs in the front of the eye, causing a black eye. This is also often the result of trauma, such as a ball hitting the eye.
Scratches on the eyes
Self-care
Scratches on the cornea (cornea) or sclera (hard sclera) happen quickly from a dust but also from unexpected sources such as a baby’s fingernails or tree branches. This type of eye injury makes the eyes susceptible to contamination with bacteria or fungus. Certain types of bacteria and fungi enter the eye through a scratch, sometimes resulting in vision loss in as little as 24 hours. An eye infection mainly occurs when the scratches on the eye are dirty or contaminated. The patient avoids rubbing the eye and does not wear oppressive or tight eye protection because this provides an ideal, warm and dark environment that bacteria like. The patient closes his eyes and then applies a paper cup, an eye mask that is not too tight, or a non-pressure sterile bandage to both eyes. He then immediately visits the ophthalmologist.
Professional medical care
These wounds often require careful microsurgical treatment. The ophthalmologist always first checks whether the patient has any foreign object in the eye (alien body) by means of an X-ray. After the operation it is important to prevent an eye infection. This is done via local (applied to the skin) and general antibiotics, atropine eye drops and possibly local corticosteroids. The ophthalmologist closely monitors the patient for these types of wounds, as persistent vitreous hemorrhage, retinal detachment (ablatio retinae) or a traumatic cataract may occur afterwards.
Metal or iron in the eye
This type of eye injury occurs when the patient hits another metal object with a metal object (for example, hammer on chisel). But a fishing hook, for example, also penetrates the eye. The patient often experiences little pain in this accident because the entrance wound of the metal is small and often invisible to the naked eye. That is why the ophthalmologist always takes an X-ray to detect the piece of metal. The ophthalmologist immediately removes a piece of iron from the eye. This is occasionally possible with the help of a magnet if the particle is freely in the eye. However, if the piece of metal is deeper in the posterior eye segment or stuck in the eye wall, surgery is required. This type of surgery is known as a vitrectomy (flax surgery in the eye). The patient receives strict follow-up after the operation (post-operative) and he also takes medication according to correct eye drop guidelines to prevent possible infection. With this type of eye trauma, it is important that the ophthalmologist detects iron particles in the eye as best as possible. If there is still iron in the eye, this often results in siderosis. This is a condition in which iron particles deposit in epithelial cells in the eye, such as in the retinal pigment epithelium. As a result, the patient develops brown cataract and secondary chronic glaucoma. Siderose has toxic effects on the retina. This causes the patient to have reduced vision and even blindness may occur if the metal piece remains in place.
Eyelid wound
Self-care
If the foreign object is under the upper eyelid, the attendant will have the patient look upwards. The supervisor holds the eyelash of the upper eyelid between the thumb and index finger with one hand. With the other hand, the counselor holds a fine object in the center of the outside of the eyelid and folds the eyelid over this object. By inverting (turning over) the eyelids, it is possible to remove the object with a compress. If this does not work, the patient consults an ophthalmologist.
Professional medical care
The patient always visits the ophthalmologist for this type of wound. He examines the wound on the eyelid thoroughly because it is important that the eye itself is not injured. He sutures the eyelid wound, paying attention to the aesthetic and functional result (eye closure, blinking, eyelash position, etc.). When a tear (laceration) occurs close to the medial canthus, damage to the tear ducts often occurs. The ophthalmologist carefully sutures this wound and locates the tear ducts so that the patient will certainly not have any problems with a watery eye.
Superficial eye wounds
A wound to the conjunctiva normally does not require medical treatment. A subconjunctival hemorrhage (bleeding under the conjunctiva of the eye) often looks worse than it actually is. The patient has no loss of vision and usually no pain. It is important that the patient is sure that all underlying structures such as the sclera (hard sclera, outer hard membrane) are still intact. The patient may remove foreign objects that are clearly visible and that lie superficially (the whites of the eyes). He does this with the help of a moist compress or the tip of a handkerchief in a sufficiently lit environment. He gently moves the speck of dirt to the corner of his eye. He always wipes towards the nose and does not touch the pupil. Often the object disappears through the tears of the eyes. If the object does not come out or if it is not in the white of the eye, it is necessary to see an ophthalmologist as soon as possible.
Dust in the eye
Self-care
Dust, sand and other dirt can easily get into the eye. This dirt often disappears spontaneously by blinking or tearing. Rubbing the eye or squeezing the eyelids often makes the foreign substance disappear. Pressing on the eye is not recommended. Persistent pain, eye irritation, sensitivity to light (photophobia), and redness are indications that medical treatment is needed. The foreign object may be on the cornea or under the upper eyelid. In that case, the patient always visits an ophthalmologist.
Professional medical care
The ophthalmologist first instills local anesthetics (local anesthetic medicines) into the patient’s eyes. He then uses a needle held tangentially to remove the substance. A small drill is sometimes necessary to remove the excess rust around the fabric. After this ophthalmic treatment, the patient uses local antibiotics for several days. The patient also wears a pressure bandage because in this way the epithelial defect usually heals quickly.
Burning of the eye
When the eye is burned, the eye is very red. The patient has severe pain when exposed to light and squints the eyelids.
Chemical combustion
Risk factors Some factors increase the risk of a chemical burn of the eye, in particular:
- the use of household products such as cleaning agents, garden chemicals, solvents or other chemicals
- working in the construction sector (cement, plastering lime)
- working in an industrial environment (lyes, sulfuric acid, etc.)
Self-care These eye injuries are a medical emergency. The supervisor immediately rinses the eye or eyes on site for ten to thirty minutes. He uses copious amounts of water for this. The attendant positions the patient with the head back and to the side. He ensures that the eyelids are open and then slowly applies lukewarm water to the eyeball, not with a strong stream or with cold water because the eye can then become hypothermic. Rinsing with a saline solution is also permitted. If the patient wears contact lenses and they do not disappear when rinsing, the patient tries to remove them after rinsing. The attendant then cleans the eyes again. After rinsing the eyes, the supervisor covers the eyes with a non-pressure sterile bandage. This is necessary because otherwise there is a risk of the eye fluid being pushed away and even of enucleation (removal of the eyeball from the eye socket). The supervisor then immediately takes the patient to the hospital or ophthalmologist.Please note: It is important not to rinse the eyes with water but with a copper sulphate solution in case of phosphorus burns.Professional medical care The ophthalmologist also cleans the eyes and sometimes uses a local anesthetic. When the patient has serious chemical burns due to alkaline substances such as lime, lye, drain cleaners or sodium hydroxide in refrigeration systems, the eye conjunctiva (conjunctiva) and cornea (cornea) are completely coagulated. This means that the blood supply in the anterior segment of the eye is compromised due to the clotting of the blood vessels, resulting in damage to the cornea. The patient usually undergoes many treatments over a long period of time. The prospects for this are often less good. In burns caused by acids, the haze on the cornea often disappears and the patient has a good chance of recovery.
Heat
The skin of the eyelids contains a burn when exposed to heat. The patient often has no other symptoms. However, if deeper burns occur, eye injuries do occur. Lagophthalmia, a condition in which the patient cannot close their eyes, may develop.
UV beams
Symptoms Exposure to welding rays or the sun’s UV rays, not wearing proper eye protection or skiing at higher altitudes can cause photokeratitis, sometimes also known as snow blindness or “welding eyes”. The cornea is inflamed, which is very painful for the patient and is accompanied by photophobia (hypersensitivity to light), tearing and eyelid spasm (blepharospasm). The pain does not occur immediately, but six to twelve hours after exposure to UV rays.Self-care With lasog it is important that the patient stays in a dark environment. It is also important to wear sunglasses with this type of burn. The patient self-administers cold compresses to the affected eyes and then immediately goes to the ophthalmologist.Professional medical care The ophthalmologist prescribes local mydriatics (pupil dilating eye drops) and temporarily a few drops of local anesthetics. When the patient applies this treatment, his vision recovers and all symptoms disappear.An eye injury in combination with a headache requires medical advice from an ophthalmologist / Source: Geralt, Pixabay
Seek medical attention (ophthalmologist) for eye injuries
In a number of circumstances it is important to seek urgent medical attention, especially when:
- The patient experiences symptoms of nausea or headache with eye pain (this may indicate a symptom of glaucoma or stroke: insufficient blood supply to the brain with mental and physical symptoms)
- A chemical has gotten into the eyes
- An uncontrollable bleeding occurs
- A change in vision (such as blurred vision or double vision) occurs
- An object has entered the eyeball
- The eye is painful and red
Interview
The ophthalmologist should obtain a complete history about the foreign body in the eye. This is important for the treatment and the possible medical consequences. A detailed description of the lesion provides information about the material and size of the foreign object in the eye (copper, iron, vegetable matter, etc.). During certain events, multiple foreign bodies are sometimes present in the eye. This is, for example, the case with explosions and firearm damage. Small high-speed fragments of steel are easily overlooked. Examples of this are the release of fragments during the grinding of metal on metal or the release of metal during high-speed machines (such as welding). The ophthalmologist also notes whether or not the patient has used safety glasses.
Diagnostic research
A thorough examination of both eyes is recommended. A slit lamp examination is necessary to detect the entry site of the foreign body into the eye. In addition, an extensive fundus examination (fundoscopy) of both eyes is necessary. Furthermore, if a chamber angle problem is suspected, the ophthalmologist will perform a gonioscopy (inspection of the drainage angle to detect glaucoma).A radiographic examination (fundus photography) of the involved eye is often sufficient to determine the presence of most foreign bodies. A CT scan (without contrast) is better at determining the location, as well as detecting certain materials that cannot be seen on an X-ray, such as glass. An ultrasonography (eye ultrasound) is helpful in detecting a foreign object in the eye that is not detectable with an X-ray. In addition, ultrasonography makes it possible to inspect the eye structures and the presence of an exit wound. Ultrasonic biomicroscopy can also be used if damage to the chamber angle is suspected. If there is a metal foreign object in the eye, an MRI scan is not recommended.
Reaction to foreign materials in the eye
The eye’s response to a foreign body lodged in the eye varies widely depending on the material, sterility and location. Materials such as stone, sand, glass, porcelain and plastic generally cause few problems. Other materials such as zinc, aluminum, copper and iron are more potentially toxic and more likely to cause problems. Pure copper is very toxic and therefore prompt removal is recommended. Iron- or copper-containing materials that enter the eye may cause delayed degenerative changes such as siderosis (buildup of iron dust in the tissues) and chalcose (buildup of copper dust in the tissues), respectively. To reduce the risk of sympathetic ophthalmia (form of uveitis, an eye inflammation), it is sometimes necessary to perform an enucleation. In this surgical procedure, the ophthalmologist removes a traumatized eye without hope of visual recovery.
Prognosis of foreign body in the eye
The prospects of a foreign body in the eye depend largely on the mechanism, location and extent of the injury, the material involved and the speed of treatment.
Complication: Endophthalmitis
Endophthalmitis, a severe inflammation in the eyeball, occurs in 2-7% of penetrating injuries. The incidence is higher in:
- a foreign object in the eye
- eye injuries involving plant substances
- patients with dirty wounds in the eye
- patients from a rural area
The risk of endophthalmitis can be reduced by rapid wound closure, removal of the foreign object in the eye and the preventive use of antibiotics. The ophthalmologist administers these antibiotics intravenously, subconjunctivally (under the conjunctiva) or intravitreally (in the vitreous). Bacillus cereus is responsible for almost one in four cases of post-traumatic endophthalmitis. This aggressive bacterium often leads to severely reduced vision or loss of the eye. Intraoperative cultures are necessary if the ophthalmologist suspects that an infection is present.
Prevention of eye injuries
Preventing eye injuries is not always possible, but they can be reduced thanks to a number of tips. The patient does this by wearing eye protection when using power tools, hammers, or other tools. Safety glasses are also important when working with toxic chemicals. Furthermore, eye protection is recommended when cycling or in windy and dusty environments. Participating in sports increases the risk of an eye injury, especially in contact sports. Safety glasses are also highly recommended in these circumstances.
read more
- Eyeball injury: Blunt or deep object in the eye
- Eye discharge from eye infections, contact lenses, or eye injuries
- Chemical burns: Treatment of chemical burns