EYE INJURIES

The human body is truly a miracle of engineering, from head to toe.  Your skull is just one example. It’s shaped in such a fashion that your eyes are recessed in bony sockets, which helps to protect them from injury. Despite this, there are many different activities of daily living, not to mention daily survival, that can cause traumatic injury to your eyes.

Here are some:

• Accidents while using tools
• Splatter from bleach and household chemicals
• Debris flung while doing yard work
• Grease splatter from cooking
• Chopping wood
• Hot objects near your face, like a curling iron (do people still use curling irons?)

The list goes on and on; heck, you could damage your eye by popping a cork on a bottle of champagne (if you could find champagne off the grid).

The grand majority of eye injuries are avoidable with a little planning but, despite this, it’s likely that the group medic will have to deal with someone’s eye injury at one point or another.

Foreign objects in the eye cause immediate symptoms, especially if they injure the sensitive cornea. You will see the victim complain of:

• Eye pain or pressure
• Tearing up
• Light sensitivity
• Frequent blinking
• Redness (a “bloodshot” eye)

The patient will usually tell you that they feel something in their eye. The most common location will be under the upper eyelid.

The most important thing to do when anyone presents to you with eye pain is a careful examination. Use a moist cotton swab to lift and evert the eyelid, that is, turn the eyelid inside out. Have you patient move their eye up, down, and to the sides. This will allow you to closely examine the area. Sometimes, all it takes to remove debris is some clean (not necessarily sterile but drinkable) water used as irrigation to flush it out. Alternatively, touch lightly with a moist Q-tip to dislodge it.

Let’s say you looked, and there’s no foreign object. Take a closer look at the “cornea”. The cornea is a clear layer of tissue over the colored part of the eye (the ‘iris”) which exists for purposes of protection and to help with focusing.

When this layer of tissue is scratched, it’s called a “corneal abrasion”. This type of injury is pretty common, and perhaps the most likely you’ll encounter. As the cornea is rich in pain receptors, the patient will probably be uncomfortable. They’ll complain that they feel a “grain of sand” in their eye. Abrasions on the cornea may be hard to see, however, without special fluorescein eye drops. Consider lubricating eye drops to help ease the discomfort. Healing usually occurs within a day or two.

A high-speed impact is usually required to actually embed a foreign object in the eye. Mostly seen in explosions or (more commonly) power tool accidents, debris may impale the eye and cause significant pain.  Difficult to remove even in the best of circumstances, expect some scarring and some loss of vision if it’s on the cornea or pupil. Below you’ll see links to two short videos where a sterile needle (and local anesthetic drops) is used to remove metal particles from the cornea.

(By the way, unless some long-term disaster has left you as the highest medical asset left, leave this stuff to qualified professionals)

After cleaning with water and using antibiotic drops, the recovering eye needs to rest and heal. Cover with an eye pad or the bottom of a paper cup and tape the whole thing in place. Your eyes track together, so it’s better to cover both. You can see Nurse Amy demonstrate this technique for eye injuries with a triangular bandage in the video linked below. Ibuprofen is useful for pain relief. Over the next few days, the eye should heal by itself.

An ounce of prevention is worth a pound of cure, so be sure to wear eye protection whenever you’re performing any activity that could possibly cause an eye injury, such as shop work, target shooting, or using power tools. Anyone who is close to you when you’re doing these activities should also wear protective gear. Other things to consider:

• When working in the yard, watch out for low hanging branches;
• before mowing the yard, remove loose objects in your path.
• Make sure that your kids never point water under force (say, from a garden hose) at someone’s face.
• Put in your contact lenses carefully; don’t sleep in them.
• Keep fingernails trimmed short.
• Use a grease shield when you’re using a frying pan.

Occasionally, blunt trauma to the eye or even simple actions like coughing or sneezing may cause a patch of blood to appear in the white of the eye or, more rarely, between the cornea and the iris. A subconjunctival hemorrhage occurs when small blood vessels within the eye tear and trap blood underneath the white conjunctiva. Luckily, this type of hemorrhage is rarely dangerous, and will go away on its own without any treatment.

A hyphema causes the eye to bleed between the iris and the cornea. If there is a loss of vision associated with the hyphema, however, there is more cause for concern. Evaluate this injury the same way you would check for abrasions.

There’s not much you can do about this in austere settings, but keeping the patient’s head elevated will allow blood to drain to the lower part of the eye chamber and help preserve vision. Cool compresses applied to the affected eye are also recommended.

In future videos, we’ll revisit eye infections as well as teach you how to deal with chemical burns to the eye. We’ll also talk about natural remedies for some common eye issues.

Joe Alton MD

Don’t forget to check out Nurse Amy’s entire line of medical kits, books, and supplies at store.doomandbloom.net. You’ll be glad you did.