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Eye Injuries
Caring for the eyes in an emergency

'Be careful! You’ll poke your eye out.' It seems that parents are often ridiculed for saying this, but their fears are reasonable. Sight depends on one of the most delicate and sensitive organs in the body, the eye. Around the home, garden, workplace or sports field, an eye can be injured very easily. It is important to always take special care to avoid eye injuries.

Parents should ensure their children play safely and avoid playing with or throwing things that can cause eye injuries. Adults should always wear protective goggles or masks when working with power tools or chemicals. Sports injuries to the eye are also common. The right protective gear for the sport is essential, especially with racquet sports and games such as hockey.

All eye injuries are potentially serious. If an eye is injured, proper first aid, given right away, may prevent partial or complete loss of eyesight.

First Aid Measures

When performing first aid, always wash your hands first and put on latex gloves if they are available.

Particles in the eye

A particle of sand, grit or a loose eyelash on the eyeball or under the eyelid causes discomfort and inflammation of the tissue around the eye. When this happens, the eye becomes pink or reddish in colour. Tears may not be enough to loosen and wash away such particles.

If the patient is wearing contact lenses, ask for them to be taken out before trying to remove a particle from the eye.

Removing a particle from the upper eyelid

Begin by using the lashes of the lower eyelid to sweep away the particle from the upper eyelid. Tell the patient to gently hold the eyelashes of the upper eyelid and pull the lid straight out and then down and over the lower eyelid. Let go of the eyelashes. The lashes of the lower lid may sweep away the particle as the upper lid slides over the lower lid. Try this a couple of times.

If this doesn’t work, expose the inner surface of the eyelid to find and remove the loose particle using the following steps:

• Seat the patient facing a good light. Steady the head and ask the patient to look down.
• Expose the inner surface of the upper eyelid by placing the stick of a cotton tipped applicator at the base of the upper lid. Press the lid gently backwards.
• Gently hold the upper eyelashes between the thumb and index finger.
• Pull the lid away from the eye and up and over the stick.
  Roll the stick back to turn the eyelid outward and expose the underside.
• If you can see the particle, and it is not on the coloured part of the eye or sticking to the eyeball, remove it with the moist corner of a facial tissue, clean cloth or cotton tipped applicator.
• Let the upper eyelid return to its proper position. If the pain and discomfort do not go away, put a dressing on the eye and get medical help.

Removing a particle from the lower eyelid

• Seat the patient facing a light.
• Gently draw the lower eyelid down and away from the eyeball while the patient looks upward.
• Wipe the particle away with the moist corner of a facial tissue, clean cloth or cotton tipped applicator.

Removing a particle from the eyeball

• Shine a light across the eye, not directly into it - the light will often cast a shadow of the particle, showing its location.
• If the particle is loose and it is not embedded in the cornea, remove it with the moist corner of a facial tissue or clean cloth. If the light fails to locate a particle in the eye, do not continue – further attempts to find and remove the particle may irritate the eye.
• Bandage the injured eye as described below.

When you cannot safely remove a particle from the eye

• Warn the patient not to rub the eye because this may cause pain and tissue damage.
• Close the affected eye and cover with an eye or gauze pad. Extend the covering to the forehead and cheek to avoid pressure on the eye.
• Secure lightly in position with a bandage or adhesive strips.
• Give ongoing patient care and get medical help.

Injury to the soft tissue around the eyes and to the eyeball

Wounds to the eyelid and soft tissue around the eye are serious because there may be injury to the eyeball. If the eyeball is not damaged, vision should not be impaired once the soft tissue injuries have healed.

Cut eyelids usually bleed abundantly because of their rich blood supply. A dressing on the area will usually control bleeding. Do not apply pressure to the eyelid.

Blows from blunt objects may cause bruises and damage the bones that surround and protect the eyes. Blows like this may also rupture the blood vessels of the eye and damage internal eye structures, causing loss of vision. Wounds from sharp objects penetrating the eyeball are serious because of the internal damage they may cause and the infection that may result.

When giving first aid to these serious eye injuries, never apply pressure to the eyeball as this may cause more internal damage or force fluid out of the eye. This can cause permanent damage to the eye. Carefully bandage the eye, and seek medical help.

An embedded object in or near the eyeball

Give first aid for an object sticking in or near the eyeball as for any embedded object - leave the object where it is, stop the bleeding and get medical help.

Prevent the embedded object from moving since movement could cause further damage to the eyeball. Ensure there is no pressure on either the eyeball or the embedded object.

Chemical burns to the eye

The eyes can be permanently damaged by corrosive chemicals in either solid or liquid form. Ensure household cleaning products and other chemicals that could potentially cause injury to children are stored well out of their reach. Chemical burns normally cause intense pain and great sensitivity to light. Prompt treatment is essential.

• Sit or lay the patient down. Tilt the head back and turn it slightly to the injured side. If only one eye is injured, protect the uninjured eye.
• If the chemical is a dry powder, brush away whatever is on the surface of the skin.
• Flush the injured eye with cool water for at least 15 minutes. Since pain may make it difficult for the patient to keep the eye open, gently open the eye with your fingers. If the patient is wearing contact lenses, don’t waste time trying to remove them. Flushing the eye may wash out the lenses. After flushing, check for and remove the contact lenses. Lenses exposed to chemicals should be thrown away (so it doesn’t matter if they are washed away during flushing).
• Cover the injured eye or eyes with dressings. Covering both eyes so the patient can’t see may add to the stress of the incident; reassure the patient by explaining what is being done and why.
• Get medical help right away and give ongoing care.

Remember, prevention is always best. Protect your eyes at home, at work and at play.