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Eye Injuries

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Appendix A: First Aid Case and Kits, Dressings, and Bandages
Appendix B: Rescue and Transportation Procedures
Appendix C: Common Problems/Conditions
Appendix D: Digital Pressure
Appendix E: Decontamination Procedures
Appendix F: Glossary


Trauma Pictures

After reading this article, be sure to visit our trauma section for pictures of eye injuries.

Introduction

Eye injuries range from minor foreign bodies, scratches, conjunctivitis and major trauma.
When an eye is injured, there is often associated pain and panic. Individuals have a high degree of anxiety and rightfully so. The fear of loss of vision is very frightening.

When one injures an eye in the outdoors, the panic may lead to a thrashing about, running around and therefore higher risk for further injury.

One must become a psychologist at this time, decrease anxiety and follow a few basic steps. When going into the outdoors for any length of time, one should always carry an extra pair of corrective lenses, whether they are glasses or contacts. Safety straps are crucial, especially when climbing, canoeing or involved in water sports. Sunglasses are also important to decrease the effects of the sun, as well as snow blindness in the winter.

Foreign bodies of the eye

One of the most common and painful occurrence in the outdoors is a foreign body to the eye. The tiniest of foreign bodies can feel like a large rock, causing great discomfort. Individuals need to remain calm and allow someone to assess the eye.

Assessment of the eye with foreign body

  1. Spread upper and lower lids apart.
  2. Shine light from the side of an eye.
  3. The foreign body should be visible on the surface of the eye.
  4. Attempt irrigation of the eye with water. To create a good stream for irrigation, pour water in a plastic bag, put a pinhole in one end and squeeze the bag. You now have a pressurized irrigation system. If the foreign body does not dislodge, you can use a small piece of cloth or cotton ball, wet the tip and use it to remove the foreign body. You can also use a cotton-tipped applicator to gently brush the foreign body away.
  5. Always check under the upper lid, even if you have already removed a foreign body. If this is missed, scratches may continue to occur when the patient continues to blink (see photo of lid eversion and foreign body). If nothing is visualized under the upper lid, take a piece of cotton or cloth and gently sweep the everted upper lid. This will help ensure that all tiny particles are removed.
  6. It is very common for individuals to feel a foreign body sensation after a foreign body has been removed. This is most likely due to a tiny scratch on the cornea.
  7. Antibiotic eye drops are helpful as a preventative for infection if they are available in your medical kit.

To patch or not to patch, that is the question. After a foreign body is removed from the eye, it is usually better if the eye is not patched. All wounds need oxygen to heal, including eye injuries. A patch should only be given for the patient’s comfort. In fact, recent research studies have shown corneal abrasions heal slower when patched as opposed to not being patched.

Ruptured, lacerated globe of eye

One can be hammering metal tent stakes and get shards of metal into their eye, a limb may hit the eye, or one may fall, striking their face. All could potentially rupture an eyeball. Ruptured eyeballs are not always very obvious. If you should suspect a ruptured globe of the eye, immediate transportation to a health care provider is imperative. Avoid high altitudes. It is better if the individual is not airlifted out. However that may be the quickest method of transport. These eye injuries should be covered with a bulky dressing. No pressure should be applied to the eye. A plastic cup placed over the eye is helpful to prevent any pressure, as well as preventing the patient from touching or putting pressure on the eye. Observe for drainage, blood behind the eye, or a clear liquid drainage. Do not give steroids as they increase intraocular pressure.

Subconjunctival hemorrhage

Benign ruptures of blood vessels are commonly seen on the whites (sclerae) of the eyes. Causes vary, from coughing, sneezing or blood pressure increase. If trauma is suspected, evaluate very closely for a globe rupture. However subconjunctival hemorrhages are very benign. They look terrible, but always resolve in 2-4 days.

Snow blindness

Snow blindness is mild sunburn of the cornea of the eye. Symptoms do not usually occur for 6-10 hours. A burning sensation with some blurred vision is possible. Depending on the severity and degree of pain, transport needs to be assessed. Sunglasses are important to make the patient more comfortable. These individuals are usually very photophobic (sensitivity to light). These injuries are very similar to welder’s burns.




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