Out of all the injuries to occur in the outdoors, eye injuries have the potential to be one of the most painful and debilitating injuries. The most common eye injury is a foreign body in the eye. This can be caused from the wind blowing debris in the eye, a tiny wood chip from chopping kindling or even an inadvertent scratch from removing contact lenses. The smallest of foreign bodies have the tendency to feel like something the size of Texas in your eye.
Foreign bodies in the eye can range from minimal debris that can be on the surface or under the lid to moderate foreign bodies on the cornea ( the cornea is a clear protective layer over the color part of the eye) or the most severe which are impelled objects into the cornea or globe of the eye. To remove the majority of these foreign bodies, a small piece of tissue, or cotton tip applicator can be used to wipe it away. If you wet the applicator many times just touching it will make it adhere to the applicator and you will not have to sweep it. Checking under the lid is highly effective and one should learn how to flip the lid. (see video) In grade school, we used to flip our lids to scare the kids. It is a rather painless procedure. If you do not see the foreign body with inspection, carefully sweep the lid with an applicator. The person will have immediate relief. If the globe of the eye is punctured or has an embedded foreign body, DO NOT ATTEMPT TO REMOVE AN IMBEDDED FOREIGN BODY ON YOUR OWN WITHOUT MEDICAL TRAINING. THIS IS AN EMERGENCY AND IMMEDIATE TRANSPORT IS NECESSARY. If the globe of the eye appears impaled and you are in the wilderness, it is best to not fly out of the area if possible. The change in pressure occurred while flying will do more harm. However, if miles away and an evacuation by air is the only method, then of course fly out and the pilot should try to stay at the lowest altitude.
It can be beneficial to patch an eye ( see video ) to help the individual decrease pain but remember – when one eye moves so does the other. If you are concerned about a globe being ruptured, a cup or some material should be used to avoid putting pressure on the eye proper. Strongly encourage the individual to avoid touching or rubbing the eye.
Irrigation first and lots of it if possible. Have the individual lay on his/her side with the outside part of his eye towards the ground and irrigate from the nose outward. Here is a great time to use the baggie method we discussed in Irrigating Lacerations.
What is snow blindness? It is basically a burn to the cornea, that transparent membrane over the colored part of your eye. Basically, it is too much UV light from the sun and the reflectiveness rom the snow. The actual medical term is photokoeratitis. This is the same effect that one would get from looking at a welders torch without protective shield or lenses.
Red and painful eyes, headache, and watery eyes as well as photophobia ( sensitivity to light )
Rest, cool compresses, and ideally a topical pain reliever. All topical eye pain relievers are prescription only. Sunglasses would be ideal. This usually resolves in 48 to 72 hours depending on severity. In the wilderness one can make protective lenses that decrease the incoming light and work remarkably well. Please see video on making glasses in the wilderness.
The most common injury to the eyes when wearing contacts are corneal abrasions and ulcers commonly from sleeping with your contacts in. Many rationalize that one night or two sleeping with your contacts in will not make a difference. You run a chance of inducing a corneal ulcer or abrasion and your trip will most likely be cut short due to the pain. NEVER sleep with your contacts in. ALWAYS bring a pair of back up glasses and a back up pair of contacts.
Corneal abrasions and ulcers are painful especially when blinking. Cool compresses and sunglasses are very helpful. Anytime a layer of the cornea is disrupted, this allows more sunlight in which causes more pain. Antibiotic ointments or drops are effective. Transport the individual to be checked by an Optometrist or Ophthalmologist. If you cannot get in to a specialist, go to an urgent care clinic where they should be able to refer you quicker.
This is actually a common ailment that looks much more horrendous than it actually is. I probably see one a month in the clinic. This is a collection of blood between the sclera and conjunctiva. You will see a bright red bloody area on the white of the eye. This resolves in a few days and will usually go from red to yellowish green – similar to a bruise as the body absorbs the blood. Causes of these are usually vomiting hard, or coughing and sneezing. Being on a blood thinner seems to have a higher prevalence. Warm compresses should help over a few days. NO need to evacuate or head home from your outdoor adventure.
Direct blow to the eye causing blood to pool between the cornea and the iris : A tree limb to the eye or any direct blow to the globe of the eye can result in a hyphema. This will be visible when you look at the eye. Blood will pool at the base of the colored part of the eye in the 6 c’clock position. This blood will cover the iris which is the colored part of your eye. Years ago, all of these were often hospitalized over night. Now minimal ones can be treated with bedrest, having the patient lay on their back with their head elevated about 40 degrees even during sleep. They should be seen by an Ophthalmologist ASAP. Important to note: If at high altitudes, one should decrease elevation as pressure build-up would cause more pain. If you are hiking in the mountains and you by chance have Diamox on hand for high altitude sickness, it can be helpful in decreasing pain. Minor hyphemas usually resolve in about a week, BUT eye exams are imperative with monitoring of eye pressure as the blood can impede drainage and increase pressure. In moderate to severe cases, the blood will have to be drained. NO ASPIRIN OR IBUPROFEN AS THAT WILL THIN THE BLOOD AND COULD MAKE THE ISSUE WORSE.
LOST GLASSES OR CONTACTS IN THE WILDERNESS, ENCOUNTERED SNOW BLINDNESS YOU CAN MAKE A PAIR OF GLASSES IN THE OUTDOORS PLEASE SEE VIDEO.
SUPPLIES : TWIGS AND DUCT TAPE.
Medical pack: An extra pair of glasses, contacts, sunglasses, mirror to assess foreign bodies, normal saline ( not necessary water instead)
For healthcare providers : Advise carrying tetracaine and fluorescein drops as well as antibiotic drop and steroid drop. ( If the expedition is a week or longer )