The eyes are a direct extension of the brain and their surrounding tissues are among the body’s most delicate and complex structures. This is why an injury to the eye, however innocuous it may appear, could be a sight-threatening emergency. Here’s what you can do before you get to medical attention:
Poets may think of the eyes as a window to the soul, but from a more practical standpoint, they are also our window to the world. And, to a physician, they are a window to the rest of the body since general health/ill-health is reflected in the eyes.
Though the reflexes of the eyelids are very well-developed, and despite the protection offered to the eyes by their bony sockets called the orbits, the eyes are highly vulnerable to injury – the prime cause of one-eyed blindness, especially among children.
What makes quick medical attention imperative is that often there is much more to an eye injury than meets the eye. An apparently minor injury with minimal evidence of tissue damage or vision disturbance can turn out to be a sight-threatening crisis. This is especially so in case of a small, unrecognisable foreign body which brings on a hidden penetrating wound to the globe of the eye says ophthalmic microsurgeon and contact lens specialist. “Even if there is no cosmetic disfigurement or vision impairment after an eye injury, it requires quick medical attention as the time factor plays a crucial role in the prognosis (outcome). In case of an injury to the retina (which could detach spontaneously), every moment’s delay could reduce the chances of sight-saving repairs.”
Here are some of the injuries you should keep an eye out for:
The incidence of this type of superficial injury is higher among children who play in dusty environment and among factory workers like welders and grinders who are susceptible to injuries from metal particles.
Symptoms: Pain, sometimes a shooting pain, a blurring of vision, watering, redness; or the injury could be asymptomatic.
DO NOT rub the eye as this may force the foreign body in deeper. Do not scratch the eyelid or eyeball.
What to do: If the object is visible, lift it out carefully with corner of a moistened clean cloth or ear bud. If the object is visible, lift it out carefully with the corner of a moistened clean cloth or ear bud. If the object still remains, flush the eye with water. If it cannot be dislodged or seen, lightly cover the eye with a 2”x2” sterile gauze (preferably a sterile eye-pad available at the chemist) and seal it with a plaster or cellotape. Take the person to an ophthalmologist.
CONTUSION (BLACK EYE)
This is the result of an impact with a blunt object like a fist or stone, or a collision against a hard surface like a door or a person. If a retinal tear occurs in an elderly person (those with innately weak retinas, the near-sighted and those suffering from hypertension are more susceptible) quick detection and sealing of the tear by laser or cryosurgery could prevent a calamity like retinal detachment. In young persons, the retina takes longer to detach itself – it could take a couple of weeks or months after the injury for the vitreous, the jelly that holds the retina in place, to liquefy.
Symptoms: The eyelid and the surrounding tissues begin to swell and look bruised (blue). The eye may be bloodshot which indicates a haemorrhage below the conjunctiva (the colourless membrane that covers the globe) or the breakage of a superficial blood vessel. In case of a retinal tear, victims may report flashes, floaters, loss of vision or a “veil” over part or all of the visual field. If the person reports double vision, the damage may be very serious.
What to do:
- If the person wears lenses remove them first because the lens may jeopardise the oxygenation (breathing) of the cornea especially if there is a large contusion in the conjunctiva which could lead to impaired circulation and damage to the cornea.
- Apply an ice compress by placing crushed ice in a clean handkerchief and applying it over the affected eye.
- Take the person to an ophthalmologist as soon as possible to rule out internal eye bleeding, vitreous haemorrhage (bleeding into the vitreous) and retinal injury.
In the event of internal eye bleeding in the front portion of the eye (hyphema), regular – perhaps daily – visits to the ophthalmologist may be needed to check the eye pressure (the pressure of the aqueous fluid movement in the eye). If the internal bleeding is accompanied by persistently high pressure, it may lead to permanent clouding of the cornea (called ‘blood staining’) which is irreversible and may result in blindness unless corneal grafting (grafting of a donor cornea from a dead person) is done.ABRASIONS
These are scratches on the surface of the cornea caused by a blow from a blunt object, by fumes from burning food, by spluttering oil or by a stray, airborne foreign particle.
If a contact lens wearer suddenly develops severe pain, photophobia (an intolerance to light), watering and redness, it could be due to an abrasion caused by the lens especially if the symptoms are uniocular (occurring in one eye).
Pregnant and lactating women who wear contact lenses should always be watchful of abrasions as they are more prone to corneal oedema (swelling of the cornea due to hormonal changes) and abrasions.
Symptoms: Pain, sometimes a shooting pain, pricking (foreign body sensation) watering and redness; or the injury could be asymptomatic.
DO NOT rub the eye as the action may worsen the abrasions or force the foreign particle in deeper.
Do not scratch the eyelid or eyeball.
What to do: Contact lens wearers should remove the lenses as soon as possible. If the particle is visible, lift it out carefully with the corner of a moistened clean cloth or ear bud. If the object still remains, irrigate the eye with clean water from the inner corner of the eye (near the nose) in an attempt to flush out the foreign body. If the object cannot be seen, use an antibiotic eye ointment if available. Lightly cover the eye with a 2”’x2” sterile gauze and seal with a plaster or cellotape. Do not use corticosteroids as they could aggravate the abrasion or result in corneal ulceration (pits). Take the person to an ophthalmologist.
These result from an injury by a blunt or by a sharp, penetrating object. They constitute an eye emergency and require immediate hospitalization and treatment. Lacerations on the sclera (the white, opaque, outer coat of the eye) are worse than those on the accessible cornea because scleral tears are usually accompanied by damage to the choroid (the dark, vascular membrane between the sclera and the retina), the retina and the vitreous – all vital performers.
Symptoms: these depend on the size and extent of the laceration. If the laceration is large (as in case of a major accident) the eyeball may appear mutilated and there might be external haemorrhage (blood pouring out of the eye), accompanied by severe pain.
What to do: Lightly pad the eye with clean gauze and rush the person to an eye hospital. In all cases of lacerations, immediate hospitalization is required. If the optic nerve is involved, it could invite infection to the brain.
A wound or hole caused by the lodging of a foreign object in the eye is common among children playing with missiles such as darts, needles, pellets and arrows, and among factory workers.
Symptoms: pain, watery eye, blurring or loss of vision. The puncture caused by the object may or may not be visible.
DO NOT venture to remove an impaled object such as a needle or a sharp piece of metal from the eye as it could bring on infection. Besides, if the vitreous leaks it cannot be restored or replaced by the body and may cause blindness. The object should be detached within the aseptic confines of an operation theatre.
What to do: Lightly cover the affected eye and preferably the other eye as well because, when one eye moves, the other eye duplicated the movement (sympathetic eye movement), which could worsen the damage. Rush the person to a hospital as any delay could trigger an infection not only to the eye but also to the brain via the optic nerve (especially if it is served) which may bring on brain abscess or meningitis.
At the hospital, sophisticated tests like sonography or a CAT scan may need to be done to pinpoint the extent of damage and to detect any hidden object is not visible and hence left in, it could lead to sympathetic ophthalmia, a condition which brings on violent inflammation in the uninjured eye weeks to months after the injury.
Heat (fire) is the commonest cause of eye burns, other culprits being electric shock, chemical (acids and alkalis), and fumes.
Symptoms: Severe pain photophobia, swelling of the eyelids and surrounding evidence of burns.
What to do: Chemical burns: Vigorously irrigate the eyes for 10 to 15 minutes. Liberally smear an antibiotic ointment in the eye, cover the eye with a loose moist dressing, and seal with cellotape or a plaster.
Rush the person to the nearest hospital, preferably a burns hospital if there is one in the vicinity. Often, when burns over the rest of the body are serious, the eyes are neglected as the attending team tends to concentrate on the skin burns especially if they are third-degree. But,, adding the eyes to the list of permanent burns deformities can be avoided. Quickly cover the eyes to protect the cornea from drying from exposure and absence of tear secretion (if the tear glands are damaged). Symptoms of ‘dry eye’ can be treated by frequent installation of artificial tears (Moisol) and lubricating ointments.
Ina serious accident in which the orbital roof or the orbital floor is fractured, the eye-ball may pop out of the socket.
Symptoms: The patient is usually unconscious. The eye may pop out partially or hang out of the socket.
DO NOT venture to push the eye back into the socket.
What to do: If the person is unconscious, close the uninjured eye if it is open as an unconscious person has no involuntary blinking action to sweep tears across the exposed portions of the eyes. An unprotected eye will dry out quickly and become susceptible to permanent damage. Even if only one eye is avulsed, cover both the eyes with gauze and rush the person to a hospital.
These occur when the lids are either lacerated or contused by a collison, stray stone or an accident.
Symptoms: The lid is swollen and bruised. There may be bleeding from the tear.
What to do: Close the affected eye. Apply a cold compress to stop the bleeding. Pad the eye with clean gauze and take the person to an eye specialist. The tear would require stitching in layers for a good alignment with minimal scarring. If the tear duct has been damaged, it may need to be reconstructed.
Severe lacerations of the lower eyelid may lead to interruptions of the tear drainage system, so do not delay treatment.
DAMAGE TO A FALSE EYE
This may be caused by a severe blow.
What to do: Separate the eyelids and manually remove the loose pieces.
Transport the person to a hospital. If the injury is severe and the socket has been lacerated, it may need to be sutured.
Small chips breaking off the wall of arteriosclerotic (plaque-thickened) blood vessels elsewhere in the body can lodge in the central retinal artery or in smaller blood vessels.
Symptoms: Total blindness if the lodgement is in the central retinal artery; and blurred vision if it is in the smaller vessels.
What to do: This is a dire emergency and the person should be rushed to a hospital without delay. If the fluid from the anterior (forward) chamber of the eye is aspirated promptly, i.e. within 30 minutes of the occlusion, it may restore some vision. But this is rare, and the usual outcome of central retinal occlusion is complete and permanent loss of vision.
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