Eye Emergency

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 significant eye or eyelid injuries and problems. An injury to the eyelid may be a sign of severe injury to the eye itself. Many eye problems (such as a painful red eye) that are not due to injury still need urgent medical attention.

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 with 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. Ongoing damage may occur in spite of prompt treatment. It is important to flush the eye with clean water or saline while seeking urgent medical care.

Dust, sand, and other debris can easily enter the eye. Persistent pain and redness indicate that professional treatment is needed. A foreign body may threaten your vision if the object enters the eye itself or damages the cornea or lens. Foreign bodies propelled at high speed by machining, grinding, or hammering metal on metal present the highest risk.

A black eye is usually caused by direct trauma to the eye or face. Certain types of skull fractures can result in bruising around the eyes, even without direct trauma to the eye. The bruise is caused by bleeding under the skin. The tissue surrounding the eye turns black and blue, gradually becoming purple, green, and yellow over several days. The abnormal coloring disappears within 2 weeks. Usually, swelling of the eyelid and tissue around the eye also occurs.

Occasionally, serious damage to the eye itself occurs from the pressure of the swollen tissue. Bleeding inside the eye can reduce vision, cause glaucoma, or damage the cornea.

Causes

  • Blow to the eye
  • Chemical injury
  • Conjunctivitis
  • Corneal abrasion
  • Eyelid and eye cuts
  • Foreign object in the eye
  • Glaucoma
  • Head injury
  • Iritis
  • Orbital cellulitis

Symptoms

  • 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 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 victim 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 subsides.
  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 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.
  • DO NOT attempt to remove an embedded object.

When to Contact a Medical Professional

Seek emergency medical care if:

  • There appears to be any visible scratch, cut, or penetration of the eyeball
  • Any chemical gets into the eye
  • The eye is painful and red
  • Nausea or headache accompany the eye pain
  • 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 wear when using power tools, hammers, or other striking tools.
  • Always wear protective eye wear when working with toxic chemicals.

References

Yanoff, M, Duker, JS and Augsburger, JJ, et al. Ophthalmology. 2nd ed. St. Louis, Mo: Elsevier; 2004:1391-1396.

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.

First Aid for Eye Emergencies

Knowing what to do for an eye emergency can save valuable time and possibly prevent vision loss. Here are some instructions for basic eye injury first aid.

Be Prepared

  • Wear eye protection for all hazardous activities and sports-at school, home, and on the job.
  • Stock a first aid kit with a rigid eye shield and commercial eyewash before an eye injury happens.
  • DO NOT assume that any eye injury is harmless. When in doubt, see a doctor immediately.

Chemical Burns to the Eye

In all cases of eye contact with chemicals:

  • Immediately flush the eye with water or any other drinkable liquid. Hold the eye under a faucet or shower, or pour water into the eye using a clean container. Keep the eye open and as wide as possible while flushing. Continue flushing for at least 15 minutes.
  • DO NOT use an eyecup.
  • If a contact lens is in the eye, begin flushing over the lens immediately. This may wash away the lens.
  • DO NOT bandage the eye.
  • Seek immediate medical treatment after flushing.

Specks in the Eye

  • DO NOT rub the eye
  • Try to let tears wash the speck out or use an eyewash.
  • Try lifting the upper eyelid outward and down over the lower lid.
  • If the speck does not wash out, keep the eye closed, bandage it lightly, and see a doctor.

Blows to the Eye

  • Apply a cold compress without putting pressure on the eye. Crushed ice in a plastic bag can be taped to the forehead to rest gently on the injured eye.
  • In cases of pain, reduced vision, or discoloration (black eye), seek emergency medical care. Any of these symptoms could mean internal eye damage.

Cuts and Punctures of the Eye or Eyelid

  • DO NOT wash out the eye with water or any other liquid.
  • DO NOT try to remove an object that is stuck in the eye.
  • Cover the eye with a rigid shield without applying pressure. The bottom half of a paper cup can be used.
  • See a doctor at once.

Chemical burns: First aid By Mayo Clinic Staff

If a chemical burns the skin, follow these steps:

  1. Remove the cause of the burn by flushing the chemicals off the skin surface with cool, running water for 20 minutes or more. If the burning chemical is a powder-like substance, such as lime, brush it off the skin before flushing.
  2. Remove clothing or jewelry that has been contaminated by the chemical.
  3. Apply a cool, wet cloth or towel to relieve pain.
  4. Wrap the burned area loosely with a dry, sterile dressing or a clean cloth.
  5. Rewash the burned area for several more minutes if the person experiences increased burning after the initial washing.

Minor chemical burns usually heal without further treatment.

Seek emergency medical assistance if:

  • The victim has signs of shock, such as fainting, pale complexion or breathing in a notably shallow manner.
  • The chemical burn penetrated through the first layer of skin, and the resulting second-degree burn covers an area more than 3 inches (7.5 centimeters) in diameter.
  • The chemical burn occurred on the eye, hands, feet, face, groin or buttocks, or over a major joint.
  • The victim has pain that cannot be controlled with over-the-counter pain relievers such as acetaminophen (Tylenol, others) or ibuprofen (Advil, Motrin, others).

If you're unsure whether a substance is toxic, call the poison control center at 800-222-1222. If you seek emergency assistance, bring the chemical container or a complete description of the substance with you for identification.

Chemical splash in the eye: First aid By Mayo Clinic Staff

If a chemical splashes into your eye, take these steps immediately:

  1. Flush your eye with water. Use clean, lukewarm tap water for at least 20 minutes, and use whichever of these approaches is quickest:
    • Get into the shower and aim a gentle stream of lukewarm water on the forehead over the affected eye. Or, aim the stream on the bridge of the nose if both eyes are affected.
    • Or, put your head down and turn it to the side. Then hold your affected eye open under a gently running faucet.
    • Young children may do best if they lie down in the bathtub or lean back over a sink while you pour a gentle stream of water on the forehead over the affected eye or on the bridge of the nose for both eyes. Remember to flush for at least 20 minutes no matter which method you choose.
  2. Wash your hands with soap and water. Thoroughly rinse your hands to be sure no chemical or soap is left on them. Your first goal is to get the chemical off the surface of your eye, but then you need to make sure to remove the chemical from your hands.
  3. Remove contact lenses. If they didn't come out during the flush, then take them out.
  4. Caution:

    • Don't rub the eye this may cause further damage.
    • Don't put anything except water or contact lens saline rinse in the eye, and don't use eyedrops unless emergency personnel tell you to do so.

Seek emergency medical assistance After following the above steps, seek emergency care or, if necessary, call 911 or your local emergency number. Take the chemical container or the name of the chemical with you to the emergency department. If readily available, wear sunglasses because your eyes will be sensitive to light.

Corneal abrasion (scratch): First aid By Mayo Clinic Staff

The most common types of eye injury involve the cornea the clear, protective "window" at the front of your eye. Contact with dust, dirt, sand, wood shavings, metal particles or even an edge of a piece of paper can scratch or cut the cornea. Usually the scratch is superficial, and this is called a corneal abrasion. Some corneal abrasions become infected and result in a corneal ulcer, which is a serious problem.

Everyday activities can lead to corneal abrasions. Examples are playing sports, doing home repairs or being scratched by children who accidentally brush your cornea with a fingernail. Other common injuries to the cornea include splash accidents contact with chemicals ranging from antifreeze to household cleaners.

Because the cornea is extremely sensitive, abrasions can be painful. If your cornea is scratched, you might feel like you have sand in your eye. Tears, blurred vision, increased sensitivity or redness around the eye can suggest a corneal abrasion. You may get a headache.

In case of injury, seek prompt medical attention. Other immediate steps you can take for a corneal abrasion are to:

  • Use saline solution, if available, or clean water to rinse the eye. Use an eyecup or small, clean glass positioned with its rim resting on the bone at the base of your eye socket. If your work site has an eye-rinse station, use it. Rinsing the eye may wash out an offending foreign body.
  • Blink several times. This movement may remove small particles of dust or sand.
  • Pull the upper eyelid over the lower eyelid. The lashes of your lower eyelid can brush a foreign body from the undersurface of your upper eyelid.

Take caution to avoid certain actions that may aggravate the injury:

  • Don't try to remove an object that's embedded in your eyeball. Also avoid trying to remove a large object that makes closing the eye difficult.
  • Don't rub your eye after an injury. Touching or pressing on your eye can worsen a corneal abrasion.
  • Don't touch your eyeball with tweezers, cotton swabs or other instruments. This can aggravate a corneal abrasion.

Foreign object in the eye: First aid By Mayo Clinic Staff

If you get a foreign object in the eye, try to flush it out with clean water or saline solution. Use an eyecup or a small, clean glass positioned with its rim resting on the bone at the base of your eye socket.

To help someone else:

  • Wash your hands.
  • Seat the person in a well-lighted area.
  • Gently examine the eye to find the object. Pull the lower lid down and ask the person to look up. Then hold the upper lid while the person looks down.
  • If the object is floating in the tear film on the surface of the eye, try flushing it out. If you're able to remove the object, flush the eye with a saline solution or clean, lukewarm water.

Caution

  • Don't try to remove an object that's imbedded in the eyeball.
  • Don't rub the eye.
  • Don't try to remove a large object that makes closing the eye difficult.

When to call for help
Seek emergency medical assistance when:

  • You can't remove the object.
  • The object is imbedded in the eyeball.
  • The person with the object in the eye is experiencing abnormal vision.
  • Pain, redness or the sensation of a foreign body in the eye persists after the object is removed.
© Copyright Philippine Academy of Ophthalmology. All Rights Reserved 2012. Powered By: MAGCON Graphic Design