"It's All Fun and Games Until Someone Loses an Eye!"
Some of the phrases we learn in kindergarten still ring true as adults. One of my favorites is, “It’s all fun and games until someone loses an eye.”
I’ve been blessed my whole life with good vision, and was blissfully unaware of how miserable an eye injury or even the inconvenience of putting in contacts can be. Unfortunately, that changed one day, and I’ve never been the same.
I was bending over in the dark, searching for something on the floor. My eyes were open wide, like that’s actually going to help me see in the pitch dark. I whacked my wide open eye on the corner of my nightstand and basically scraped the entire top layer of my cornea (the clear covering of the colored part of the eye) right off.
Now, I’m an emergency physician. I see patients like this all the time, and I used to think they were being just a little bit of a wuss. The agony of that injury, which totaled less than 1 square centimeter of my body, is the worst thing I ever experienced. My tricky immune system decided to add to the fun by reacting to the injury and attacking my eyeball, a condition called iritis. I spent the next three weeks in a constant state of nausea from the pain, with a blood red eyeball, unable to tolerate any light in either eye, and unable to see anything other than big blurry outlines. Those fun eye charts? You know the big E right at the top? I couldn’t even tell you where it was; let alone where it was pointing.
Despite my paranoia about another eye injury, this past summer, my 3 year old poked me in the eye while changing a diaper, and I had a repeat of my previous adventure with partial blindness and suffering. I am eternally grateful that both of my eye injuries eventually healed, and that I have normal vision and no long term problems. I was lucky, and I must admit that I learned a few things from my experience. I’m now a lot nicer to patients who come to the emergency room with an eye problem. I’m also a lot more cautious about wearing protective glasses.
Eye injuries are a common reason to visit the emergency department, and for good reason. Injuries are the most common reason to lose vision in one eye, and it can sometimes be difficult to tell the difference between a minor injury and one that can threaten your eye. As a general rule, it’s a good idea to keep all paired body parts - legs, arms, kidneys, testicles, eyes - as a set for as long as possible. Preferably, if you start out with two at birth, you’d like to have two when you die.
One of the most important things you can do for an eye injury is to prevent it from ever happening. You should wear good quality safety glasses during any activity that involves debris, dust, or flying objects. One research study estimated that over 85 percent of people seen in the emergency room for an eye injury were not wearing safety glasses at the time of the injury.
Fortunately, most eye injuries that are seen in the emergency department are minor. However, even minor injuries can be extremely painful and scary. Here is a quick rundown on common eye complaints, and some tips on what to do if this happens to you.
One of the most common eye problems we see in the emergency department is pink eye, also known as conjunctivitis. Most of the time, this is a result of a virus that has infected the clear covering of the eye.
The eye becomes red, itchy, irritated, and watery. Sometimes, it can be matted shut with thick goop after sleeping. This will usually go away on its own, but it is highly contagious. Except for very rare circumstances, pink eye is not a threat to your eye or vision. You can wipe away the drainage with a warm wet washcloth, and that can also help the irritation. If it is not clearly improving within 3-4 days, see a doctor for an evaluation. Wash your hands like a “germaphobe” unless you want to share the fun with the whole family, because this is easily spread through touching.
Contact lens wearers are at a higher risk for a more serious infection that can often start out like pink eye. This is due to the fact that you stick a foreign body (aka contact) into your eye once a day. If you develop eye pain or irritation, significant redness, and it is not improving after you remove the contact, see a provider as soon as possible. Do not wear your contacts again until you see a provider and your symptoms are gone.
Those “wear for 30 days straight” contacts? Not a good idea, according to my friends who are ophthalmologists. They can cause significant eye injuries, and my eye doctor buddies just laugh when I have to call them about prolonged contact lens wear. The poor patient then gets to enjoy several days of putting eye drops in every hour round the clock to make sure they don’t have a hole eaten through the covering of their eyeball. Take your contacts out every night; it’s much safer for your peepers.
One of the most common injuries we see is a corneal abrasion, like I was lucky enough to experience. This happens when the eyeball itself is touched by something that it shouldn't be, and part of the clear covering of the eye is scratched off. These also tend to be benign and heal rather quickly, but they are miserable to deal with. If you get poked in the eye by something and your pain is not improving after a few hours, being evaluated in an emergency room is a good idea to make sure the injury is only on the surface of the eye, and to start treatment with antibiotic eye drops to help protect the healing eye.
They can also help decrease the incredible amount of pain that you’re going to be in for a few days.
Foreign bodies in the eye are another great reason to visit your local emergency department. If you get something in your eye, rinsing the eye with large amounts of water can be eye-saving. Many businesses have eye wash stations, but rinsing in a sink or jumping in the shower and letting the water run through the eye will also work. After you’ve given it a good 10-15 minutes rinsing, then head to the hospital. If it is a solid foreign body, the water will often help rinse the material out of the eye. Liquids in the eye will be diluted by the water, decreasing the chance that the liquid could injure the eye. Once you get to the ER, we will often start by rinsing the eye again, so wear a shirt you don’t mind getting wet.
Another condition we see frequently is called a subconjunctival hemorrhage. It sounds horrible, looks worse, and is completely harmless. This occurs when a blood vessel bursts on the surface of the white portion of the eye. It turns that whole area red, but it is completely painless and your vision is normal. Many times, people will wake up with these and notice while brushing their teeth. Sometimes they can occur after coughing or sneezing. The redness fades on its own after a few weeks.
All of the above injuries tend to heal fairly quickly, within a few days, with minimal long term problems. However, more serious injuries can occur, and these require immediate attention in an emergency room.
Some warning signs of more serious injuries include:
- Object impaled in the eye — DO NOT attempt to remove the object from the eyeball. Cover the injured eye and the object to prevent movement (paper cups taped to the face work well for this use). Patch the good eye as well, as it will decrease movement of the injured eye.
- Severe pain in the eye
- Significant decrease in vision —if you are unable to count the number of fingers someone is holding up in front of your face with the affected eye, you should seek evaluation right away.
- Eye injuries that occur when working on metal, glass, or other materials that can create small shards that can fly into the eye — You should be wearing eye protection anyway, but these injuries can be very dangerous.
- Any foreign body that you can’t remove yourself with water or a gentle Q tip.
- Any chemical exposure to the eye.
- Burns to the eye.
- Cuts to the eyelids — Eyelids are very delicate structures, and even small cuts can interfere with the eye’s ability to open and close properly.
- Eye injuries that are associated with explosions or fast moving objects (grinding metal, etc.) — The eyeball is soft and squishy, so small objects can actually penetrate the eye and leave almost no visible hole.
- If you notice that your pupil is no longer round — Some people have pupils that aren’t round; if it’s been that way your whole life, that’s ok. If it used to be round and it isn’t any more, that’s a problem.
- If your eyes no longer move normally — Your eyeballs should move together when you look up, down, and side to side. If one eye suddenly stops moving in one of those directions, seek evaluation as soon as possible.
Emergency physicians are trained to evaluate and care for all manner of eye conditions, and most of the time can provide the care that you need right there in the emergency room. Occasionally, if you have a more serious problem, your emergency physician will consult with an eye specialist on call to ensure you receive the best treatment.
It’s much easier to avoid eye injuries rather than deal with them after they have happened, so good quality eye protection is a smart investment. If you’re unlucky enough to have an eye injury or infection, have a low threshold to be seen by a doctor. Most of the time, your injury will be minor and will heal in a few days; however, if you do have a serious injury, it is important to be seen quickly to have the best chance to preserve your eye and your vision.
About the Author: Dr. Torree McGowan is an emergency physician in northern California. She went to medical school at Oregon Health and Sciences University, and completed her emergency medicine training in San Antonio, TX. When not working, Torree enjoys riding horses and spending time with her husband and their two sons.