Eye emergencies

Definition

Eye emergencies include cuts, scratches, objects in the eye, burns, chemical exposure, and blunt injuries to the eye or eyelid. Since the eye is easily damaged, any of these conditions can lead to vision loss if left untreated.

Considerations

It is important to get medical attention for all major eye or eyelid injuries and problems. Eye problems (such as a painful red eye) that are not due to injury still need urgent medical attention.

Watch this video about: Corneal injury

Causes

• A black eye is usually caused by direct trauma to the eye or face. The bruise is caused by bleeding under the skin. The tissue around the eye turns black and blue, gradually becoming purple, green, and yellow over several days. The abnormal color disappears within 2 weeks. Usually, swelling of the eyelid and tissue around the eye also occurs.
• Certain types of skull fractures can cause bruising around the eyes, even without direct injury to the eye.
• Occasionally, serious damage to the eye itself occurs from the pressure of a swollen eyelid or face. A hyphema is blood in the front area of the eye. Trauma, often due to a direct hit to the eye from a ball, is a common cause.

Chemical injuries

• A chemical injury to the eye can be caused by a work-related accident or by common household products, such as cleaning solutions, garden chemicals, solvents, or many other types of chemicals. Fumes and aerosols can also cause chemical burns.
• With acid burns, the haze on the cornea often clears and there is a good chance of recovery.
• However, alkaline substances -- such as lime, lye, commercial drain cleaners, and sodium hydroxide found in refrigeration equipment -- may cause permanent damage to the cornea.
• Damage may occur, even with prompt treatment. It is important to flush out the eye with clean water or salt water (saline) while seeking urgent medical care.

Eyelid and eye cuts

• An injury to the eyelid may be a sign of severe injury to the eye itself.

Foreign object in the eye and corneal injuries

• The cornea is the clear (transparent) tissue covering the front of the eye.
• Dust, sand, and other debris can easily enter the eye. Persistent pain and redness are signs that you need treatment.
• A foreign body in the eye may threaten your vision if the object enters the eye itself or damages the cornea or lens. Foreign bodies thrown at high speed by machining, grinding, or hammering metal have the highest risk.

Symptoms

Depending on the type of injury, any of the following symptoms may be present:

• Bleeding or other discharge from or around the eye
• Bruising
• Decreased vision
• Double vision
• Eye pain
• Headache
• Itchy eyes
• Loss of vision
• Pupils of unequal size
• Redness -- bloodshot appearance
• Sensation of something in the eye
• Sensitivity to light
• Stinging or burning in the eye

First Aid

Take prompt action and follow the steps below if you or someone else has an eye-related injury.

SMALL OBJECT ON THE EYE OR EYELID

The eye will often clear itself of tiny objects, like eyelashes and sand, through blinking and tearing. If not, take these steps:

1. Tell the person not to rub the eye. Wash your hands before examining it.
2. Examine the eye in a well-lighted area. To find the object, have the person look up and down, then from side to side.
3. If you can't find the object, grasp the lower eyelid and gently pull down on it to look under the lower eyelid. To look under the upper lid, you can place a cotton-tipped swab on the outside of the upper lid and gently flip the lid over the cotton swab.
4. If the object is on an eyelid, try to gently flush it out with water. If that does not work, try touching a second cotton-tipped swab to the object to remove it.
5. If the object is on the eye, try gently rinsing the eye with water. It may help to use an eye dropper positioned above the outer corner of the eye. DO NOT touch the eye itself with the cotton swab.

A scratchy feeling or other minor discomfort may continue after removing eyelashes and other tiny objects. This will go away within a day or two. If the person continues to have discomfort or blurred vision, get medical help.

OBJECT STUCK OR EMBEDDED IN EYE

1. Leave the object in place. DO NOT try to remove the object. DO NOT touch it or apply any pressure to it.
2. Calm and reassure the person.
3. Wash your hands.
4. Bandage both eyes. If the object is large, place a paper cup or cone over the injured eye and tape it in place. Cover the uninjured eye with gauze or a clean cloth. If the object is small, cover both eyes with a clean cloth or sterile dressing. Even if only one eye is affected, covering both eyes will help prevent eye movement.
5. Get medical help immediately.

CHEMICALS IN THE EYE

1. Flush with cool tap water immediately. Turn the person's head so the injured eye is down and to the side. Holding the eyelid open, allow running water from the faucet to flush the eye for 15 minutes.
2. If both eyes are affected, or if the chemicals are also on other parts of the body, have the person take a shower.
3. If the person is wearing contact lenses and the lenses did not flush out from the running water, have the person try to remove the contacts AFTER the flushing procedure.
4. Continue to flush the eye with clean water or saline while seeking urgent medical attention.
5. After following the above instructions, seek medical help immediately.

EYE CUTS, SCRATCHES, OR BLOWS

1. If the eyeball has been injured, get medical help immediately.
2. Gently apply cold compresses to reduce swelling and help stop any bleeding. DO NOT apply pressure to control bleeding.
3. If blood is pooling in the eye, cover both of the person's eyes with a clean cloth or sterile dressing, and get medical help.

EYELID CUTS

1. Carefully wash the eye. Apply a thick layer of bacitracin, mupirocin, or other antibacterial ointment on the eyelid. Place a patch over the eye. Seek medical help immediately.
2. If the cut is bleeding, apply gentle pressure with a clean, dry cloth until the bleeding stops.
3. Rinse with water, cover with a clean dressing, and place a cold compress on the dressing to reduce pain and swelling.

DO NOT

• DO NOT press or rub an injured eye.
• DO NOT remove contact lenses unless rapid swelling is occurring, there is a chemical injury and the contacts did not come out with the water flush, or you cannot get prompt medical help.
• DO NOT attempt to remove a foreign body or any object that appears to be embedded in any part of the eye. Get medical help immediately.
• DO NOT use cotton swabs, tweezers, or anything else on the eye itself. Cotton swabs should only be used on the eyelid.

When to Contact a Medical Professional

Seek emergency medical care if:

• There appears to be a scratch, cut, or something has gone into (penetrated) the eyeball
• Any chemical gets into the eye
• The eye is painful and red
• Nausea or headache occur with the eye pain (this may be a symptom of glaucoma or stroke)
• There is any change in vision (such as blurred or double vision)
• There is uncontrollable bleeding

Prevention

• Supervise children carefully. Teach them how to be safe.
• Always wear protective eye gear when using power tools, hammers, or other striking tools.
• Always wear protective eye gear when working with toxic chemicals.
• Always wear protective eye gear when cycling or participating in sports where there is a high likelihood of injury to the eye, such as indoor racket sports.

References

Butler FK Jr. The eye in the wilderness. In: Auerbach PS, ed. Wilderness Medicine. 5th ed. Philadelphia, Pa: Mosby Elsevier;2007:chap 25.

Mitchell JD. Ocular emergencies. In: Tintinalli JE, Kelen GD, Stapczynski JS, et al, eds. Emergency Medicine: A Comprehensive Study Guide. 6th ed. Columbus, OH:McGraw-Hill;2006:chap 238.

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