Eye injuries

(Survival Manual/6. Medical/c) General Clinic/Eye injuries)

 A.  First Aid
Take prompt action and follow the steps below if you or someone else has an eye-related injury.
Pasted from <http://www.nlm.nih.gov/medlineplus/ency/article/000054.htm>

Small object on the eye or eyelid
The eye will often clear itself of tiny objects, like eyelashes and sand, through blinking and tearing. If not, take these steps:
1.  Tell the person not to rub the eye. Wash your hands before examining it.
2.  Examine the eye in a well-lighted area. To find the object, have the person look up and down, then side to side.
3.  If you can’t find the object, grasp the lower eyelid and gently pull down on it to look under the lower eyelid. To look under the upper lid, you can place a cotton-tipped swab on the outside of the upper lid and gently flip the lid over the cotton swab.
4.  If the object is on an eyelid, try to gently flush it out with water. If that does not work, try touching a second cotton-tipped swab to the object to remove it.
5.  If the object is on the eye, try gently rinsing the eye with water. It may help to use an eye dropper positioned above the outer corner of the eye. DO NOT touch the eye itself with the cotton swab.
A scratchy feeling or other minor discomfort may continue after removing eyelashes and other tiny objects. This will go away within a day or two. If the person continues to have discomfort or blurred vision, get medical help.

Object stuck or embedded in the eye
1.  Leave the object in place. DO NOT try to remove the object. DO NOT touch it or apply any pressure to it.
2.  Calm and reassure the person.
3.  Wash your hands.
4.  Bandage both eyes. If the object is large, place a paper cup or cone over the injured eye and tape it in place. Cover the uninjured eye with gauze or a clean cloth. If the object is small, cover both eyes with a clean cloth or sterile dressing. Even if only one eye is affected, covering both eyes will help prevent eye movement.
5.  Get medical help immediately.

Chemicals in the eye
1.  Flush with cool tap water immediately. Turn the person’s head so the injured eye is down and to the side. Holding the eyelid open, allow running water from the faucet to flush the eye for 15 minutes.
2.  If both eyes are affected, or if the chemicals are also on other parts of the body, have the victim take a shower.
3.  If the person is wearing contact lenses and the lenses did not flush out from the running water, have the person try to remove the contacts AFTER the flushing procedure.
4.  Continue to flush the eye with clean water or saline while seeking urgent medical attention.
5.  After following the above instructions, seek medical help immediately.

Eye cuts, scratches, or blows
1.  If the eyeball has been injured, get medical help immediately.
2.  Gently apply cold compresses to reduce swelling and help stop any bleeding. DO NOT apply pressure to control bleeding.
3.  If blood is pooling in the eye, cover both of the person’s eyes with a clean cloth or sterile dressing, and get medical help.

Eye lid cuts
1.  Carefully wash the eye. Apply a thick layer of bacitracin, mupirocin, or other antibacterial ointment on the eyelid. Place a patch over the eye. Seek medical help immediately.
2.  If the cut is bleeding, apply gentle pressure with a clean, dry cloth until the bleeding subsides.
3.  Rinse with water, cover with a clean dressing, and place a cold compress on the dressing to reduce pain and swelling.

DO NOT
•  DO NOT press or rub an injured eye.
•  DO NOT remove contact lenses unless rapid swelling is occurring, there is a chemical injury and the contacts did not come out with the water flush, or you cannot get prompt medical help.
•  DO NOT attempt to remove a foreign body that appears to be embedded in any part of the eye. Get medical help immediately.
•  DO NOT use cotton swabs, tweezers, or anything else on the eye itself. Cotton swabs should only be used on the eyelid.
•  DO NOT attempt to remove an embedded object
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B.  Foreign Body, Eye Treatment
<http://www.emedicinehealth.com/foreign_body_eye/page7_em.htm>

Self-Care at Home
You should be able to care for minor debris in your eye at home. If you have trouble removing something in your eye or if a larger or sharper object is involved, you should seek medical attention. If you are wearing a contact lens, it should be removed prior to trying to remove the foreign body. Do not put the contact lens back into your eye until your eye is completely healed.
For minor foreign bodies, such as an eyelash, home care should be adequate.
1.  Begin by rinsing your eye with a saline solution (the same solution used to rinse contact lenses). Tap water or distilled water may be used if no saline solution is available. Water will effectively flush out your eye, but the chlorine in most tap water can cause varying levels of irritation. How you wash out your eye is less important than getting it washed out with great amounts of water.
…..•  A water fountain makes a great eye wash. Just lean over the fountain, turn on the water, and keep your eye open.
…..•  At a sink, stand over the sink, cup your hands, and put your face into the running water.
…..•  Hold a glass of water to your eye and tip your head back. Do this many times.
…..•  If you are near a shower, get in and put your eye under the running water.
…..•  If you are working outside, a garden hose running at a very modest flow will work.
…..•  If washing out your eye is not successful, the object can usually be removed with the tip of a tissue or a cotton swab.
2.  Pull back the eyelid by pulling down on the bottom edge of the lower lid or by pulling up on the upper edge of the upper lid.
3.  Look up when evaluating for a foreign body under the lower lid.
4..  Look down when evaluating for a foreign body under the upper lid. You will often need someone to help you in this case.
5.  Be very careful not to scrape the tissue or the cotton swab across your cornea, the clear dome over the iris.
6.  For larger foreign bodies or metal pieces, you should seek medical care, even if you are able to safely remove them at home.
…..•  If the foreign body is easily accessible and has not penetrated your eyeball, you may be able to remove it carefully with a cotton swab or a tissue.
…..•  If you have any question about penetration of the eye, do not remove the object without medical assistance.
…..•  If you cannot remove the object or if you continue to have the sensation that something is in your eye even after the debris is removed, you should seek medical care.
7.  After the foreign body is removed, your eye may be red and tearing.
8.  You may protect your eye by cutting the top part off of a Styrofoam or paper cup and placing the cup over your eye. If you place a cup over your eye, do not put any pressure on the injured eye, because it could cause additional injury to your eye.
…..•  This cup can be taped in place and will form a cover over your eye.
…..•  It is very important not to rub your eye or to apply any pressure to your eye. If you have punched a hole in your eye (called a ruptured globe or eyeball), you can do significant damage by pressing or rubbing your eye. This is especially true with small children who will rub their eyes to try to remove the debris.

Medical Treatment
•  For scratches on your cornea (called corneal abrasions), the usual treatment is an antibiotic ointment and/or antibiotic eye drops and pain medicine. If the abrasion is large (greater than 50% of the corneal surface), then it may also be treated with a patch.
•  Any noted damage to the iris, the lens, or the retina requires immediate evaluation by an ophthalmologist and may or may not require surgery.
•  A ruptured eyeball requires surgery by an ophthalmologist.
•  If no other injury is noted, hyphema (blood in between the cornea and the iris) requires close follow-up care with an ophthalmologist.
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C.  Corneal Abrasion
<http://www.utahmountainbiking.com/firstaid/eyes.htm>
Scenario: A branch brushes your face and there’s sharp pain in your eye. It hurts to blink.
[Image at right: Description: A corneal abrasion is a scratch over the clear part of the eye. It causes an irritable   or sharp “foreign body” sensation in the eye. Often it feels like   something scratchy is stuck under the upper eyelid, because the eyelid rubs over the scratch as it blinks. With a very minor corneal abrasion, the eye may simply feel “dry.” The abrasion usually heals quickly, often overnight.
Except for a   little redness, the eye with a corneal abrasion often looks normal. Painful eyes should be checked, regardless of how “normal” they look.]

Concerns:
A large abrasion may take a long time to heal, and can cause an inflammatory reaction within the eyeball. Sometimes a sharp object cuts into the deep tissue of the cornea. This can permanently change your vision. Debris in the scratch, such as shreds of tree bark, can lead to infection and ulceration of the cornea. There may still be a scratchy particle stuck under your upper eyelid, and it will continue to damage your cornea. So don’t take chances with your eyeballs. If the scratchy sensation hasn’t gone away after you get back to your car (around an hour), head for the ER.

See the doctor if:
– the scratchy sensation doesn’t go away promptly
– vision is blurry
– the eye is sensitive to light
– there is deep pain
– you develop mucous in the eye

Immediate care:
Don’t rub the eye. It’s best to rest a minute, letting the eye water, with the eyelids as relaxed as possible. If the symptoms don’t go away, turn around and head back.

Foreign Body
You get a chunk of something in your eye. The eye begins to sting and water.
[Image at left: Description: Foreign material in the eye can scratch the cornea. There may be an irritable, stinging, or sharp “foreign body” sensation in the eye.  Sharp bits of sand or wood can rapidly dig themselves into the tissue of the   cornea or underside of the upper lid.
Foreign body under the lower eyelid margin. Particles are   easier to remove here, but are actually more common under the upper eyelid.]

Concerns:
The foreign matter can damage the cornea — the part of the eye you see through. Debris in the eye can lead to infection and ulceration of the cornea. A scratchy particle under your upper eyelid will continue to scratch up your cornea. So don’t take chances with your eyeballs. If the scratchy sensation hasn’t gone away after you get back to your car (around an hour), head for the ER.

See the doctor if:
– the scratchy sensation doesn’t go away quickly
– vision is blurry
– the eye is sensitive to light
– there is deep pain
– you develop mucous in the eye

Immediate care:
Don’t rub the eye. (Rubbing the eye can grind loose sharp particles into the cornea!) It’s best to rest a minute, letting the eye water, with the eyelids as relaxed as possible. If the symptoms don’t go away, turn around and head back.

If you’re far out in the woods and the eye is extremely watery and painful, you can try to dislodge the particle. Usually it will be under the upper eyelid. Assuming your squirt bottle has clean water in it, flush the eye. Turn your head sideways, so the squirt bottle can aim slightly downward as it faces the eye. With the eyelids gently closed, put your index finger and thumb together and press against the eye, as though you were going to take hold of your eyelids.

[ Image at left: While holding gentle pressure, spread the thumb and finger to pull the lids aside. Now squirt for several seconds. If the scratching continues, grasp the upper eyelashes and pull the eyelid straight forward away from the eye. Squirt up into the slit between the eyelid and eyeball. Then rest a minute to see if   the symptoms subside.     Position of  the squirt bottle to flush debris from the eye. The victim is lying down, and   the bottle is aiming towards the gap between the retracted upper eyelid and   eyeball. The rescuer is pulling up on the brow and upper eyelid, while the   victim looks towards the feet.]

If you can feel exactly where the particle is, you could try to rub it off. Wash your hands thoroughly. Now pull the eyelid forward, with your thumb on the underside. As the eyelid comes forward, put a free finger (middle finger) against the cleft between the eyelid and eyebrow, then rotate the pad of the thumb so slips under the edge of the eyelid. Run it sideways along the underside of the eyelid where you feel the particle. Be careful about this — not every doctor would think it’s a good idea — because you’re getting germs from your finger into the eye. And (unless you succeed in removing a particle) the more you mess with your eye, the worse it will feel.

If the foreign body sensation persists, leave the eye alone. There may be an abrasion of the cornea, which feels exactly like something scratchy is still in the eye. Go have the eye

D.  UV Eye damage
<http://vision.about.com/od/eyeexaminations/a/sun_protection.htm>
<http://en.wikipedia.org/wiki/Photokeratitis>
Ultraviolet radiation harms more than just your skin. Too much unfiltered sunlight can harm your eyes by damaging the lens and even the retina.
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1.  Cataracts
•  Overexposure to the sun’s UV rays can damage the lens of the eye and increase your risk of developing cataracts.
•  Cataracts occur when the lens of the eye becomes cloudy, rendering all images blurry and out of focus.
•  Cataracts are the leading cause of blindness.
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** See also the 4dtraveler post: (Survival Manual/6. Medical/c) General Clinic/Eyeglass repair & emergency glasses) which discusses how to make emergency glasses for several survival scenerios.

2.  Retinal damage – Macular Degeneration
•  Prolonged exposure to UV radiation can damage the retina (the sensitive lining of the eye used for sight).
•  Macular degeneration occurs when the macula (an area in the retina) is damaged, thus causing loss of central vision.
•  While studies have yet to prove what causes macular degeneration, it is possible that overexposure to the sun’s UV light may be a contributing factor.
•  Most forms of retinal damage are irreversible.

3. Snow Blindness
Exposure  to  reflected sunlight from  snow, ice, or water, even on grey overcast days, can result in  sunburn of the tissues comprising the  surface  of  the   eye, as well as  the retina, producing snow blindness. Symptoms. Symptoms  may not be apparent until  up  to 12 hours after exposure. The   eyes initially  feel  irritated and  dry; then, as  time passes, eyes feel as though they are full of  sand. Blinking and moving the eyes may be extremely painful.  The eyelids are usuallyred, swollen, and difficult  to open.

Remedial Action: A  mild case will heal spontaneously in a few days, but you can  obtain some relief by applying cold compresses and a lightproof  bandage.  An ophthalmic  ointment can be  applied hourly to relieve pain and lessen the inflammatory reaction.

Prevention: Snow blindness can be prevented by constant  use  of   sunglasses or a  tinted helmet  visor.  If  the  glasses or helmet are lost, an emergency  set of goggles can be made from a  thin piece of leather, cardboard, or other lightproof material. Cut the material the width of the face with  horizontal  slits over the eyes. These  improvised  goggles can be held in place with string or cord from the parachute shroud lines  attached to the  sides and tied  at  the back of the head.