In survival scenarios, the sense that will be the biggest determinant of your chances of success is that of vision. Many people have one vision defect or another, and would be wise to have corrective Lasik surgery or, at least, some spare eyeglasses in their medical storage. Others with perfectly normal eyesight may end up with a traumatic injury that damages the eye is some way. In this article, we’ll talk about eye trauma.
The conformation of the human skull is such that your eyes are slightly recessed in bony sockets. This helps protect them from injury. Despite this, there are many activities of daily living that can be traumatic to your eyes.
Here are just a few of the ways you can injure your eyes:
- Accidents while using tools.
- Splatter from bleach or other household chemicals.
- Lawn mower or gardening tool mishaps.
- Grease splatter from cooking.
- Chopping wood.
- Hot appliances near your face, such as curling irons or hair dryers.
The grand majority of these injuries are avoidable with a little planning and, perhaps, protective eyewear. Despite this, it’s likely the group medic will come upon an eye injury at one point or another.
Simple trauma to the eye often results in a collection of blood under the skin (a “black eye”). In these cases, apply a cold pack around, but not on, the eye for 20 minutes to keep down swelling. The injury is serious only if the patient develops double vision or other changes in eyesight.
If there’s a foreign object in the eye, there will be immediate symptoms, including:
- Eye pain or pressure
- Tearing up
- Light sensitivity
- Frequent blinking
- Redness (a “bloodshot” eye)
The patient will communicate that they feel something in their eye. The most common location will be under the upper eyelid. Use a moist cotton swab to lift and evert the eyelid. This will allow you to effectively examine the area. Clean (drinkable) water can be used as irrigation to flush out the foreign object. Alternatively, touch lightly with the moistened swab to dislodge it.
It’s rare for a foreign object to actually impale the eye. You would need a high-speed impact for this to happen, mostly seen in explosions.
To remove small metallic foreign objects from the eye (or any wound) an “eye magnet and loop” instrument can be used. Any magnet is useful, but the special instrument has a handle you hold like a pencil. The handle allows the medic to get close while maintaining direct visualization of both the eye and the foreign object. The tip is dull to prevent further injury. The loop side has a small nylon loop which can remove other objects gently. To use the eye magnet and loop instrument:
• Clean the magnet and loop sides with an antiseptic like alcohol and allow to dry.
• Hold the magnet side close to the metallic object to remove.
• If the metallic object is lifted but not 100% removed then use the loop side to complete the removal.
• For other small eye (or wound) foreign object removals, the loop can help gently lift them out.
Even in the best of circumstances, foreign objects are difficult to remove without causing scarring and vision loss, especially if it’s on the cornea or pupil.
Let’s say you looked, and there’s no foreign object. Take a close 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 or damaged, it’s called a “corneal abrasion.” A corneal abrasion is relatively common, especially in those who wear contact lenses. The patient will probably complain to you that they still feel as if there’s a grain of sand in their eye, especially when they blink.
Sometimes the injury of an eye cannot be seen easily. To enhance visualization of the eye, and help diagnose the issue, a special “fluorescein” dye can be added to the eye. A (commercially-available and inexpensive) “cobalt blue” light is then used to highlight lacerations. To use:
- Place one or two drops of sterile eye wash or saline to the fluorescein strip.
- Ask the patient to look upwards.
- Pull down the lower lid of the injured eye.
- Touch the strip to the surface of the eye located under the lower lid.
- Release the lid and ask the patient to blink a few times to spread the orange dye.
- Use a cobalt blue light to visualize the eye; defects will appear bright green.
- The dye will wash out of the eye naturally, but eye wash may help if desired.
The abraded eye needs to rest and heal. After flushing it clean with water and using antibiotic drops (if available), cover the closed eye with an eye pad and tape or an eye patch. Alternatively, the bottom of a paper cup can be substituted if an eye pad or patch is painful. It’s wisest to cover both eyes, as the open eye will move around and the closed eye will follow its movements. As covering both eyes may agitate the victim, a small peephole can be made through which the unaffected eye can see. This will limit movement but relieve anxiety. Over the next few days, the eye should heal by itself. Use ibuprofen for pain relief if necessary.
For prevention of corneal damage, consider the following:
- 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.
- When working in the yard, watch for low hanging branches; Be sure to 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 contact lenses carefully; don’t sleep in them.
- Keep fingernails trimmed short.
- Employ a grease shield when 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. This is called a “subconjunctival hemorrhage” and, although not painful, can be alarming to the patient. It’s usually harmless, however, and will clear up in about a week without treatment.
A more serious condition is a “hyphema.” In hyphemas, there is bleeding covering the iris and, perhaps, the pupil. The patient may experience pain and vision may be blurry, cloudy, or otherwise affected. If so, there is more cause for concern. Evaluate this injury as described for abrasions.
Treatment for hyphemas involves keeping the patient’s head elevated to allow any blood to drain to the lower part of the eye chamber. This strategy may help preserve vision. Cool compresses applied to the affected eye are also recommended, perhaps using the natural substances mentioned earlier. Recovery may be slow.
In an event where the eye is exposed to noxious chemicals, burns and other reactions may occur. Rapid action is required in these cases. Hold the eye wide open while flushing with warm water. This should be done for at least 15 minutes in severe cases. Avoid getting the other eye wet, as chemical runoff may damage it.
Eye damage from chemical exposure can be severe. The medic must quickly:
- Remove contact lenses if applicable.
- Tilt the head in the direction of the affected eye.
- Hold the eyelids away from the eyeball while having the victim move the eye in all directions.
- Rinse the area with warm, clean water for 10-20 minutes.
- Wash any eyewear with soap and water.
- Bandage both eyes with a moist dressing.
(NOTE: Nurse Amy has put together an outstanding “Eye Care Emergency Kit” for the family medic in survival settings. Check it out by clicking the link below)
Joe Alton MD
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