Eye Injuries

Anatomy of the Eye

Image
Anatomy of the Eye

Sharp vision depends on many factors. The parts of the eye work together to bend (refract) and focus light rays. For normal vision, light must focus onto the retina. 

  • Cornea - Light enters the eye through this clear, dome-shaped tissue that covers the front of the eye. The cornea bends light rays to help focus them. Problems with its shape can affect vision.
  • Pupil - This circular window in the center of the iris opens and closes to let the right amount of light into the eye.
  • Iris - This is the colored part of the eye. It contains muscles that open (dilate) and close (constrict) the pupil.
  • Lens - This disk of clear tissue behind the pupil changes shape to help focus light.
  • Retina - This thin layer of light-sensitive tissue lines the inside back of the eye. It sends images as electrical impulses to the optic nerve.
  • Optic nerve - This nerve carries signals from the retina to the brain. The brain then interprets these signals to make images. These images are what you see.
Black Eye

A black eye is really a bruise around your eye. It is often caused by an injury to your face or head. It is not normally due to an injury to the eye itself. The swelling and black-and-blue color happen because of blood and fluids collecting in the skin around your eye. A black eye should return to normal in 1 or 2 weeks.


When to go to the emergency room (ER)

In many cases, a black eye is a minor injury. It can be treated at home with cold packs and pain medicine. But get medical care right away if you have any of these symptoms:

  • A change or loss of vision
  • Trouble moving your eye up and down or side to side 
  • Blood inside your eye, or bleeding from your nose or ears
  • Fluid leaking from your eye

What to expect in the ER

While in the ER, you may expect the following: 

  • Your injury will be examined.
  • Your vision, the way your eye moves, and the bones around your eye will be checked.
  • You may have a fluorescein stain test. This uses dye and a special light to check for damage to the surface of your eye.
  • An X-ray or other tests may be done.
  • Depending on the results of your exam and tests, you may be referred to an eye specialist (ophthalmologist).

Follow-up

While your eye is healing, call your healthcare provider if you notice any of these symptoms:

  • Swelling that doesn't improve after a few days
  • Increased or severe pain
  • Changes in your vision
  • Warmth, redness, or pus near the bruise

To reduce pain and swelling from a black eye:

  • Wrap a think towel around a cold pack before applying it to your eye.
  • Apply ice packs every 20 minutes while you're awake for the first 24 hours.
  • Use warm compresses every 20 minutes while you're awake for the next 24 hours.
Hyphema

Hyphema is bleeding in the front part of your eye. The cornea is the clear cover on the front of your eye. The colored part of your eye (the iris) lies behind it. The space between them is called the anterior chamber. An injury to your eye is the most common cause of bleeding in this space.


When to go to the emergency room (ER)

Hyphema is a medical emergency. Call your healthcare provider or have someone take you to the nearest hospital. Don't use any home remedies before going to the healthcare provider or hospital. Signs and symptoms include:

  • Bleeding in the front part of your eye, which often forms a layer as it settles. In severe cases, the entire anterior chamber is filled with blood.
  • Eye pain or nausea
  • Decreased vision. Even a small amount of blood in the anterior chamber can make it hard to see.

What to expect in the ER

  • A healthcare provider will give you a complete eye exam, using a microscope with a bright light (a slit lamp microscope).
  • Your vision and the pressure within your eye will be checked.
  • Mild hyphema may be treated at home. You will need to limit your activity, keep your head raised, and use eye drops and an eye shield. In addition, eye drops will be prescribed for you.
  • If bleeding is severe or your eye pressure increases, you may be admitted to the hospital for treatment. 
  • Hyphema often goes away on its own in time. If not, you may have a procedure to remove the blood from your eye.

Follow-up

If you’re treated at home, you are likely to see your healthcare provider each day for 3 to 5 days. You may then be checked several times over the next few weeks. This is vital because bleeding may come back again even after treatment. Other parts of your eye may have been injured if trauma caused the bleeding. Traumatic hyphema raises your risk for increased eye pressure (glaucoma). For this reason, you should have routine eye exams for the rest of your life.

Corneal Injury

An eye injury can hurt your cornea. Your cornea is the clear layer on the front of your eye. It protects your eye from dust and germs. And it helps filter out harmful UV (ultraviolet) rays. The cornea also helps to focus light entering your eye. Your cornea is made of strong proteins, but it can be damaged. A slight cut or scratch (abrasion) to the cornea can be very painful. A minor scratch can heal in 1 or 2 days. A bad abrasion or a hole (puncture) in the cornea can be very serious. These are medical emergencies.


Something in your eye

If you think you have something small in your eye, flush it with water right away. Pull your upper lid out and over your bottom lid. This will help increase the flow of tears across your eye. If these methods don’t work, call your healthcare provider. Never try to remove an object from your eye that doesn’t flush out easily with water. Doing so may cause more damage.


Call 911

Call 911 if you have:

  • Severe eye pain
  • A puncture injury or bad abrasion
  • Something in your eye that you can’t flush out with water
  • A very swollen or painful eye after removing an object
  • A chemical burn
  • An object embedded in your eye. Cover both eyes with a sterile compress and keep both eyes closed while you wait for help. Don't put any pressure on your eyes.

What to expect in the ER

For minor abrasions 

Minor abrasions are often treated with eye drops or ointment. You may be given antibiotics to prevent infection. Most abrasions heal in 1 or 2 days. To help rule out more serious injuries, you may have tests including:

  • A standard eye exam to check how well you can see
  • A Seidel test, which uses a special dye to look for a hole in the surface of your eye

Depending on the results of these tests, you may be referred to an eye care provider (ophthalmologist).

For serious abrasions or punctures

You will be referred directly to an ophthalmologist for emergency treatment. An eye specialist is needed to reduce further damage and possible vision loss.

Foreign Object in the Cornea

Your cornea is the clear layer on the front of your eyeball. It focuses light and helps protect your eye from dust and germs. A foreign object can get into the cornea itself. A trapped speck of dirt or grit is often a minor problem. But anything metal, or an object that goes through (pierces) your cornea, can cause severe damage. For example, the cornea can be damaged from foreign bodies that occur while grinding metal. The small pieces of metal travel toward the eye at high speed.


When to go to the emergency room (ER)

The longer you wait, the greater the chance of injury or infection. Seek emergency medical help right away for any of the following:

  • An object in your eye that you can't flush out with water
  • Your eye remains very swollen or painful after an object has been removed
  • An object embedded in your eye. Cover both eyes with a sterile compress and call 911
  • The front of your eye (cornea) is white or hazy
  • Blood in your eye (hyphema), in between the clear cornea and the colored iris
  • You are having trouble seeing

What to expect in the ER

  • A healthcare provider will ask about your injury and examine your eye.
  • You may be given eye drops to ease any mild pain.
  • The provider may use a microscope with a bright light to help examine your eyeball. He or she may put a special dye (fluorescein dye) on the cornea to help see the object more clearly.
  • The provider may remove a loose foreign object. This may be done with a cotton swab, irrigating your eye with water, or sometimes with a small needle, scoop, or drill tool.
  • Severe injuries are likely to be treated by an eye specialist (ophthalmologist).
  • Antibiotic eye drops and possibly pain medicine will be prescribed if you are discharged home

Follow-up

Call your healthcare provider if you notice any of these symptoms after going home:

  • Fever of 100.4°F (38°C) or higher , or as directed by your healthcare provider
  • Increased redness or eye pain
  • Drainage from your eye
  • Blurred or decreased vision
Ultraviolet Keratitis

Ultraviolet keratitis, also called snow blindness, is when exposure to too much UV (ultraviolet) light hurts your cornea. This causes pain and affects your vision. The cornea is the clear cover on the front part of your eye. It helps focus light. It protects your eye from dust and germs. The cornea also filters UV rays before they enter your eye.


Risk factors

UV damage to your cornea can be caused by:

  • Reflected sunlight from sand, ice, snow, or water
  • Sunlamps used in tanning beds
  • Halogen lamps or welding torches
  • Lightning
  • Exposure to direct sunlight for too long

When to go to the emergency room (ER)

Symptoms of ultraviolet keratitis appear 6 to 12 hours after damage happens. Call your healthcare provider or 911right away if you have any symptoms after light exposure. Symptoms include:

  • Eye redness and tearing
  • Eye pain, which may be severe and get worse when you move your eyes
  • Flashing spots or flashes of light
  • Changes in your vision
  • Feeling like you have something in your eye
  • Sensitivity to light
  • Seeing bright circles (halos) around a light source
  • Eyelid swelling or twitching

What to expect in the ER

A healthcare provider will ask about your exposure to UV light. He or she will check your eyes carefully using a microscope with a bright light (a slit lamp). A special fluid (fluorescein dye) may be placed on your cornea. This helps to show damage more clearly.

Depending on your symptoms, you may have 1 or more of the following treatments:

  • Medicines to help reduce pain
  • An antibiotic ointment to prevent an eye infection
  • An eye patch to help with healing and ease mild pain

Follow-up

Call your healthcare provider if new eye symptoms develop or your pain or vision problems last more than 48 hours.

Wear sunglasses that block 100% of both UVA and UVB radiation whenever you spend time outdoors. Gray, green, and brown lenses provide the most protection.