Eye Injuries

The eye is well protected by its surrounding bone and by the speed with which the lids close tightly when danger threatens. The eyes often escape unharmed even when facial injury is severe and the bony socket (the orbit) has been fractured.

The most serious injuries involve the cornea and the internal crystalline lens, leading to corneal scars and cataract. Blunt injury to the eyeball tends to be less dangerous, but, if severe, may cause rupture and collapse of the globe, loss of contents and detachment of the retina. Lesser degrees of injury may cause the internal lens to become opaque (concussion cataract) or may cause bleeding into the jelly of the eye (vitreous haemorrhage).

Blunt injuries, even if quite minor, may result in bleeding into the front chamber of the eye (hyphaema). This will affect vision for a day or two until the blood is absorbed. Usually there is full recovery, but later there may be the complication of an abnormal rise in the pressure within the eyeball (secondary glaucoma). Recurrent bleeding is a serious complication, tending to cause permanent visual loss.

The greatest danger is from small, high-speed objects. Many children have suffered severe eye injuries by being stabbed or poked with sticks, air-gun pellets, or small stones thrown up by rotary grass cutters.

Both adults and children suffer injuries when the body is moving at speed. Penetrating injuries to the eye commonly arise from windscreen glass in car accidents, though this happens much less often now that seat belts are widely used.

Industrial accidents, too, are common, especially to people using high-speed machinery such as grinders, drills, saws, lathes or milling machines without adequate eye protection.

Small external objects (foreign bodies) in the eye are very common and usually do little harm. However, if they are placed near the centre of the cornea and are deeply embedded, they may cause some permanent loss of vision. Corneal abrasions (scratches) in which the surface layer is scraped off are very painful for a time, but will usually heal well as a new surface layer grows across. They do, however, need expert attention.

Corrosive liquids can cause severe eye injuries. Strong alkalis (such as bleach) are worse than strong acids because alkalis rapidly sink into the corneal tissue, causing irremediable damage and tissue reactions that may even make successful corneal grafting impossible.

Minor injuries, such as a surface scratch of the cornea, may be exquisitely painful. The most important symptom is loss of vision, and this should always be tested by closing the other eye.

Other signs of eye injury include:

redness surrounding the cornea,
extensive bleeding under the membrane covering the white of the eye (sub-conjunctival haemorrhage),
a line of blood inside the eye, visible at the bottom of the cornea (hyphaema),
any greyness visible on the cornea,
any visible irregularity on the cornea,
loss of the firmness of the eyeball,
a change in the shape of the pupil,
protrusion of part of the iris through the cornea

Any such signs should be reported without delay.

The exact nature of the injury may require skilled ophthalmic examination using a microscope with focused illumination (slit lamp).

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Eye protection with polycarbonate goggles is absolutely essential whenever there is any risk to the eyes, for example, when operating some kinds of high-speed industrial machinery. NHSDEC07