Eye injuries

Almost everything that happens to an eye at home or at work comes to nothing: the speck washes out with a tear, the shampoo stings for half an hour and stops, the eye goes red and settles by the evening. The difficulty lies elsewhere. A handful of genuinely serious injuries look calm at first and barely hurt, yet the window for doing something about them is minutes or hours. A splash of oven cleaner, a metal sliver off an angle grinder, a ball to the face — every one of them can mislead. What follows is how to tell the trivial from the injury that means leaving the house now, and what to do in the first few minutes.

When minutes count

Do not wait it out or leave it until morning if any of this follows an accident with the eye:

• a caustic substance has got in — oven or drain cleaner, bleach, ammonia, lime, cement, plaster, battery acid; start rinsing with water straight away and carry on doing it on the way;
• a splinter, a wire or a shard is stuck in the eye — leave it there;
• something arrived at speed: hammer on chisel, angle grinder, strimmer, lawnmower, air weapon, firework;
• vision has changed since the injury — it has dropped, gone cloudy or double, or there are flashes, a shower of floaters or a dark curtain at one side;
• blood is visible inside the eye, either as a red level in front of the iris or as a whole red field;
• the pupil has lost its round shape and is drawn out into a teardrop, or dark tissue is showing at a wound;
• pus or clear fluid is leaking from the eye and the globe feels soft;
• the eye will not move or will not open, or it hurts badly; there is vomiting, light sensitivity, headache or a high temperature.

Nobody drives in that state: ask someone to take you, or call an ambulance (across Europe the single emergency number is 112). Bring the list of medicines you take and the container of the chemical, or a photograph of its label. If surgery looks likely, do not eat or drink until a doctor says you may.

A chemical in the eye: water first, everything else after

This is the one eye injury where five minutes of delay changes the outcome. An acid burns the surface and largely stops itself, because the coagulated protein blocks its own path inwards. An alkali behaves differently: it dissolves tissue and keeps travelling deeper until it is washed away. That is why oven and drain products, slaked lime, cement and plaster mix are more dangerous than vinegar or a descaler, however much less alarming they sound.

Rinse for twenty minutes at the very least, timed by the clock, and longer still for an alkali. Any clean, cool water will do: tap, shower or bottled. Hold the lids apart with your fingers, or the eye will screw itself shut by reflex and the water will simply run down your cheek. Aim the stream from the nose outwards towards the temple so that the good eye is not splashed. Keep the flow gentle. Take out a contact lens if it has not washed out by itself. And do look under the upper lid: grains of lime and cement lodge exactly there and go on burning the cornea until somebody removes them.

There is nothing to neutralise. Acid does not get bicarbonate tipped over it, alkali does not get vinegar poured on: the reaction gives off heat on the surface of the eye itself and only makes matters worse. Water, plenty of it, and time — that is the whole of the home stage.

Something has got into the eye

An eyelash, a grain of sand, a husk, a crumb of plaster. The first thing not to do is rub: that drags the particle across the cornea and turns a nuisance into an injury. Blink and let your tears carry it out. If that fails, rinse the eye with clean water or saline. The upper lid can be pulled gently by the lashes and drawn down over the lower one; the bottom lashes often sweep out whatever is caught above.

Tweezers, matchsticks, the corner of a tissue and cotton buds never go into an eye. If the gritty feeling persists after rinsing, either the particle is sitting under the upper lid or it has already gone and left a scratch behind; both are for a doctor to sort out. They will turn the lid inside out and put in a drop of dye that makes the damaged patch of cornea visible.

A corneal scratch: why something so small hurts so much

The cornea carries nerve endings more densely than any other tissue in the body, so a tiny graze feels like a piece of glass. The usual picture is sharp soreness, streaming tears, an eye that will not open in daylight, redness and slightly blurred vision. A graze heals quickly, generally within a day or two, and a doctor may prescribe antibiotic drops so that nothing takes hold meanwhile. A tight pad over the eye is not needed.

Contact lenses deserve a paragraph of their own. Take the lens out and leave it out until the eye has healed and a doctor gives the go-ahead. Under a lens a surface graze turns into a corneal ulcer within twenty-four hours: it is warm, wet and short of oxygen under there. Pseudomonas does it fastest of all, and the ulcer it leaves behind is an opaque scar right in the middle of your sight. A red, painful eye in someone who wears lenses always means today, never tomorrow.

A blow to the eye

A ball, an elbow, a fist, a champagne cork, a bungee strap that lets go. The bruise around the eye is not itself dangerous, but the eyeball underneath is worth checking, because a blunt impact squeezes the globe and tears it from within. These are the things that matter:

• blood in the front chamber: it settles into a flat red level in front of the iris. Vision clouds and the eye aches dully. It often clears on its own but needs watching, because the pressure inside can rise and the bleeding can restart after a few days;
• a fracture of the orbital floor: double vision on looking up, numb skin over the cheek and upper lip, an eye that seems to have sunk back. After that injury you must not blow your nose, or air from the sinus will track under the skin and into the socket;
• retinal detachment: flashes in the dark, a sudden shower of floating specks, a dark curtain creeping in from the edge of the field. It may show up weeks after the blow rather than on the day, which is why these signs are worth committing to memory;
• a rupture of the coats of the eye: a teardrop pupil, a soft globe, sight lost abruptly. This needs surgery, and until then the eye is only shielded, never touched.

If a perforation is suspected, nothing is pressed against the eye — not ice, not a wad of cotton wool, not a hand. Cover it with something rigid, the base of a plastic cup will serve, and tape that to the cheekbone and forehead without any weight on the globe itself.

A burn from light

Welding without a mask, sun bouncing off snow or water, a tanning bed without goggles. Ultraviolet burns the surface of the cornea, and the treacherous part is the delay: nothing bothers you at first, and six to twelve hours later, usually at night, both eyes start to burn as though they were full of sand. The lids will not part, tears run, light is unbearable.

That burn heals in a day or two and leaves no trace, but it is worth being seen, because more serious things hide behind the same picture. At home a darkened room, cool compresses, an ordinary over-the-counter painkiller and lenses left out are what help. The anaesthetic drops a doctor uses to examine the eye are not taken home and not bought over the counter: they take the pain away but stall the healing. Preventing all of it is simple — a welding mask, and on snow and water glasses with an ultraviolet filter.

What not to do

• rub the eye or press on it;
• pull out an object that is lodged in it;
• bandage it tightly when a perforation is suspected;
• put in whatever the medicine cupboard happens to hold, above all decongestant drops, which erase the redness and with it a sign of disease;
• rinse the eye with tea, milk, herbal infusions or saliva;
• wear lenses or use eye make-up before the eye has healed;
• wait for it to pass by itself once vision has changed, however slightly.

The rare things worth knowing in advance

After a penetrating wound there is such a thing as sympathetic ophthalmia. The immune system, meeting the inner tissues of the eye for the first time through the wound, starts treating them as foreign and attacks both eyes, the uninjured one included. It happens seldom, but the catch is in the timing: the inflammation arrives weeks or even months later, long after the injury has been forgotten. That is why a wounded eye is not left half followed up, and why anyone whose other eye later turns red, hurts in the light or sees worse should be seen urgently.

The second rare disaster is much closer in time. Infection travels into the eye with the object that wounded it and unfolds over the first few days: pain builds instead of easing, the lid swells, vision falls and pus is visible inside. This is an emergency and it is treated in hospital.

How to avoid the injury altogether

Safety glasses cost less than a single trip to an eye specialist and prevent the bulk of the severe cases. Wear them for grinding, drilling, hammer and chisel work, for strimming grass, for mixing lime or cement, and for decanting acids and alkaline cleaners. Ball games and racket sports have their own protective eyewear, which is particularly sensible for children. Fireworks and air weapons deserve a line of their own: a large share of serious childhood eye injuries comes from them. And the domestic side: take lenses out overnight, never rinse them in tap water, and keep bottles of household chemicals where a child cannot reach.

Online consultation

A remote appointment settles the question that comes first: is this an irritation that will pass by itself, or a case that needs examining in person, and how soon. The doctor will go through what got into the eye and in what circumstances, look at the eye through the camera, and explain how to rinse it properly and which signs to watch over the coming days. It is also a convenient way to discuss a gritty sensation that is now into its second day, or redness in someone who wears lenses. The urgent signs in the first list are not assessed remotely — with those you go straight to be seen in person.

This material is for information only and does not replace medical advice.