Trauma

The serious discussion
Despite widespread efforts to reduce eye injuries, Prevent Blindness America estimates that there are 2,000 workplace eye injuries every day, and 10 – 20% of those lead to some type of permanent vision disability.  Overall, there are over 500,000 serious (sight-threatening) eye injuries annually from workplace, fireworks, auto and sports accidents.  In persons under 25, trauma is the leading cause of vision loss.  Wearing protective eyewear would prevent many of these serious injuries.

One of the most common eye injuries is a corneal abrasion.  A corneal abrasion occurs when the outer surface of the eye (the cornea) is scraped with a foreign object (e.g., fingernails, paper edges, dirt, contact lenses, etc.).  Since the cornea has thousands of nerve endings, corneal abrasions can be extremely painful and will usually require immediate medical attention.  Treatment usually involves removing the foreign object (if still present), applying antibiotics and patching the eye.

Serious eye injuries require immediate medical attention.  One of the most serious injuries to the eye is chemical exposure.  Damage to the eye can either be short-lived or permanent, depending on the chemical involved; alkali and acid burns are the most damaging.  The most common cause of acid burns is an exploding car battery.  When any chemical injury occurs, the eye needs to be flushed for ten minutes with water.

Other types of eye injuries are minor blunt injuries (black eye), serious blunt injuries (e.g., impact from a racket ball or other solid object), and penetrating injuries (i.e., eye is pierced by a sharp object).  Recent advances in surgical techniques have improved vision outcomes after serious injuries, particularly if the patient seeks medical care immediately.

The Three Stooges discussion
Editor’s note: Several years ago we wrote a well-received article in the Omaha World Herald regarding all those nasty eye pokes that were routinely part of Three Stooges shows.  While the paragraphs above focus primarily on the types of eye traumas, the discussion below addresses how much trauma an eye is designed to withstand.

Slapstick comedians haven’t cornered the market on eye pokes.  Each year scores of patients visit us when their eyes are poked by a finger or pencil, hit by a ball or a falling object, or damaged when they run into shelves, wires or other foreign objects.  For simplicity, we’ll aggregate all these mishaps into the term ‘minor eye trauma.’

Surprisingly, the eye can withstand a fair amount of trauma.  The brow, cheekbone and bridge of the nose form a protective shell that protects the eye from large objects.  Our blinking reflex can also protect the eye from smaller foreign objects if the eyelids are closed before impact.  Finally, the eye itself can withstand a small amount of direct trauma due to the give and take of the eye tissue and the muscles that hold it in place.

The biggest concerns with minor eye trauma are corneal abrasions, eyelid lacerations, increased intraocular pressure (IOP) and eye inflammation.  Corneal abrasions are common because many foreign objects have edges (like fingernails) that scratch the surface of the eye.  Corneal abrasions can be very painful, but patching and eye ointments can lessen the pain and prevent infection, and abrasions usually heal within two days without future complications.  Lacerations on the eyelid are troublesome because the eyelids are intricate structures and require careful wound closure.  The eye may also react to trauma with increased IOP or intraocular inflammation that can permanently damage the eye if left untreated.

If you have lid lacerations, eye pain or full or partial vision loss for more than 30 minutes after the trauma, you should call your eye doctor immediately.  In the case of major eye trauma where there is bleeding, broken bones surrounding the eye, complete loss of vision or foreign objects still remaining in the eye, you should go directly to a hospital emergency room.