Eye emergencies

• 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.

  

  See more about:
  Corneal injury

  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.
• Call immediately for emergency medical assistance if

  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.

Review Date: 1/21/2009

Reviewed By: Jacob L. Heller, MD, Emergency Medicine, Virginia Mason Medical Center, Seattle, Washington, Clinic. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.