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! 

You’ll Put Your Eye Out!

It was a mystery to mom: her 10 year-old, autistic boy suddenly was rubbing his eyes and crying.  When she pried his hands away, she saw that his eyes were red with swollen lids, and he obviously hurt.  Was it allergies?  Did pink eye come on this fast?

She checked him over to see if he had gotten into anything, felt a lump in his pocket, and pulled out the pepper spray canister that she kept in her purse!  Mystery solved.  She ran his eyes and face under cold water and brought him in.

Eye illnesses and injuries often freak people out.  Sight is important, and many fear losing it.  Eyeballs themselves are kinda freaky.  No haunted house is without missing eyeballs, misshapen eyeballs, or eyeballs in a bowl.  Eyes can be mysterious- movies and TV enhance drama by highlighting or shading an actor’s eyes. Emotional response to eye problems makes for a lot of Emergency Department visits.

The most common eye problem in the ED isn’t an emergency: conjunctivitis. Conjunctivitis is what many call “pink eye,” where the eye is red, watery, and itchy. Sometimes the eyes water clear, sometimes the discharge is green and gooey.

Most conjunctivitis is from infection, usually viral.  Like most viruses, pink eye lasts only a few days and goes away on it’s own without antibiotics.  Contrary to popular belief, pink eye is not terribly contagious, and the American Academy of Pediatrics doesn’t consider it a reason to skip school or daycare. Pink eye can also be from allergies to pollen or pet hair exposure.  This “allergic conjunctivitis” lasts as long as the child is exposed, and tends to stay watery and not get gooey and discolored.

Swelling around the eye also worries parents.  Usually baby wakes up with one eyelid dramatically swollen, and is rushed to the ER.  Baby seems fine, cooing away and not sick, but it LOOKS bad!  These are usually due to insect bites, and swelling around the eye is more dramatic than bites to other areas because of loose skin and abundant blood supply there.

In the iconic movie “A Christmas Story,” 9 year-old Ralphie Parker yearns for a Red Ryder BB gun.  A running gag is Ralphie’s subtle and not-so-subtle begging to his parents and Santa for the gun.  He is invariably turned down with the line, “You’ll put your eye out!”

At the end (spoiler alert!), Ralphie gets his BB gun and promptly shoots himself in the eye, or actually, shoots his glasses off.  Fortunately for Ralphie, his glasses saved his eye.  Unfortunately, in real life BB guns can “put your eye out.”  I’ve seen too many BB injuries to eyes and faces of kids, and too many real gunshot wounds there too.  Despite advances in eye surgery, eyesight and/or the eye itself are often lost.

Therefore, preventing eye injuries is the best way to preserve vision.  If your child is doing something with potential injury, have them wear safety glasses.  Basketball great Kareem Abdul Jabbar turned geeky protective glasses into cool.  During a college game he got his cornea (the clear dome in front of your iris and pupil) scratched.  Corneal abrasions are intensely painful, and after that he wore glasses.  Corneal abrasions can come from flying particles while woodworking, weed-eating, shooting, and from many sports.

Eye strain is another form of eye injury.  In my childhood, parents warned that watching too much TV would “strain” our eyes.  Not knowing what that meant, we ignored them.  It turns out eyestrain is real and much more prevalent today, with smaller screens that have more detail than old TVs, and kids spending way more time looking at them.  Growing up we had one TV at home, and you could tell who the rich kids were because they had two!  Now most kids have a screen in their pocket, or more likely in their faces.

Symptoms of eyestrain are watery and itchy eyes, blurry vision, headaches, and light sensitivity.  Eyestrain can be reduced by keeping screens clean, enlarging text, and rest from screen time.  Put off getting your child a phone.  Get their phone when they NEED it, not because they want it for entertainment.

Like with the Red Ryder BB gun, you don’t want them to put their eyes out!