AIEE! I’ve Hurt My Eye

This week’s guest columnist is Dr. Irena Liang, a Family Practice resident at the University Hospital and Clinics here in Lafayette.

It’s a pumpkin-decorating party, and the carving tool seems safe.  The edge is serrated, but the tip is blunt and it’s plastic, not metal.  But when you turn your back, your 8 year-old girl screams “OWW!”  She’s got her hand over her right eye, and yells, “I poked myself in the eye!  I can’t see!”

In the Emergency Department, the doctor sees a defect in the cornea, that clear dome in front of the iris and pupil.  If it’s a hole, he explains, that’s serious.  He calls the eye surgeon, who recommends starting IV antibiotics, and she’s on her way in.  Your girl may need surgery.

Eye injuries can be worrisome.  Often it’s just a scratch that heals fine, but sometimes eye pokes can lead to vision loss. The simplest injury is a scratch to the cornea, called a ”corneal abrasion.”  This means the cornea is scraped on it’s outer layer. These hurt so much that it’s hard for the child to open her eye.  They require pain control and infection prevention.  We’ll prescribe an antibiotic ointment that soothes the scratch and stops infection, and advise ibuprofen or tylenol. If not cared for properly, sometimes abrasions can become ulcerated and leave a permanent scar on the cornea, which impedes vision.

Another simple injury is the subconjunctival hemorrhage.  This is when the white of the eye gets poked, and blood pools in the outer layers.  It’s essentially a bruise of your eyeball, but the tissue is so thin and white that it’s bright red, unlike the usual blue bruising of skin.  These heal fine, though it takes a week for the blood to reabsorb.

If the eyeball is penetrated, this is serious.  Surgery may be necessary to save vision, with possibly some permanent vision loss anyway.  Even the other eye could be endangered, a phenomenon called sympathetic ophthalmia.  When one globe is penetrated, the immune system sees the eye’s interior as foreign, attacks the injured eye, and attacks the good eye as well.  Unchecked, the child’s immune system can damage both eyes.

Toddlers are explorers.  Unfortunately, many families keep poisonous substances under the kitchen sink, where toddlers go.  They grab the cleaner or dishwasher pod, open it, and poof or squirt it in their eyes.  Screaming ensues.

Chemical burns to the eye, like the poking traumas we mentioned above, can have serious consequences.  They initially impact the cornea, that clear dome in front of your iris and pupil, and burn it, causing intense pain.  Left unchecked, they can penetrate the cornea and damage deeper eye structures.

First things first-wash it out!  This is hard with toddlers and even older kids, but it’s crucial to stop the damage.  Often it takes two people, one to hold the child and another to hold the eyelids open and pour in lots of water.  After that initial wash-out, head to the Emergency Department.

In the ER, we put numbing drops in the eye to make further wash-outs less miserable.  Then we wash with saline solution multiple times, because chemicals can hide in the lacrimal sac, a tear-collecting reservoir between the corner of the eye and nasal bridge.  After one wash-out, chemicals can squirt out of that sac back into the eye and cause further burns. After this is over, we refer to the eye doctor to assess the extent of injury.

Blunt eye trauma- punches in the eye, or blows to the face with a ball, are easier.  These often don’t injure the eyeball, because it’s protected by the eyelids and brow.  Simple bruising, black eyes, and swollen eyelids are treated with ice or cool compresses, and pain medicine like Tylenol. Check your child’s vision. Blurry vision needs an eye doctor, since the shock wave from blunt injury can damage structures important for seeing.

Eye “foreign bodies,” like sand or eyelashes, can cause intense pain, and lead to corneal abrasions like we discussed above. Though they usually don’t cause serious damage, they really irritate!  If you know it’s something simple like dirt, sand, or an eyelash, washing the eye out often removes the object.  If you can see it, sometimes you can dab it out with a cotton swab.  If pain continues after removal, or your child has blurry vision, come on in! 

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