By Dr. Jeff Daniels EBS Medical Columnist
Minor eye injuries are common, and in most instances preventable. We’re all susceptible to these types of injuries because all it takes is a careless rub across the surface of your eye when you’re waking up in the morning.
Scrape away a layer or two of your cornea, and it will be very painful for a couple of days, make the eye tear continuously, and cause the white of the eye – called the sclera – to turn red from inflammation.
When a patient comes into the clinic with an irritated eye, it can be difficult at first to determine whether the eye is infected by a bacteria or virus, or it’s traumatized. One finding that easily differentiates between infection and trauma is crusting of the eyelashes, typically when waking up in the morning. Infection always causes crusting, whereas injury to the eye almost never does.
Most of the minor eye injuries we see are work related, particularly when sawdust or stone is involved. The other common cause is due to wearing contact lenses.
First, I’ll discuss work-related injuries. Use of proper protective eyewear will often eliminate contact of the eye with foreign objects that can either scratch the cornea directly, or lodge underneath the upper lid and carve a scratch with every blink of the eye.
Wearing glasses or sunglasses is not sufficient, because small objects often find their way around the edges of the lenses. However, I’ve seen even the most elaborate protective goggles fail on occasion, but at least they reduce the risk.
Sometimes a foreign object, like a small fragment of stone or tiny metal shaving, can hit the eye and stick directly to the cornea. Interestingly, this doesn’t hurt as much or cause other symptoms immediately – but over time, the eye gets redder and more irritated. Using a slit lamp, which magnifies the eye and let’s us do a careful examination, we can see the foreign object embedded within the surface layer of the cornea.
If the object is iron or steel, as you might expect in a welder’s eye, the oxygen in the cornea can cause a rust formation. This will form a ring around the foreign body, and the discolored area of cornea has to be removed along with the metal. This is easy to do using the high magnification of the slit lamp, once a topical anesthetic is put in the eye.
The other procedure we commonly perform is to remove sawdust or stone from under the lid. This takes less than a minute and involves flipping the upper lid inside out. We then use a sterile swab to wipe away the foreign material. Pain relief is immediate, but the cornea is still scratched and will hurt for a couple of days.
Contact lenses can sometimes lead to corneal abrasions – most often by sticking to the cornea when they’re too dry – so when the lens is removed, it takes some cornea with it. Thousands of tiny puncture holes can be seen on the surface of the cornea in some cases. In others, the scratch is roughly the same as if something struck the eye. Occasionally, a lens will migrate off the cornea and lodge in one of the corners of the eye, or under the upper lid.
In all cases of contact lens trauma, leaving the lens out of the eye for about a week is very important. We treat all abrasions with an antibiotic ointment, but they will nearly always heal by themselves without infection.
So, wear protective goggles if exposed to situations where something might fly up into your eyes. Take proper care of your contact lenses and don’t rub your eyes too hard when you’re tired. Hopefully you’ll avoid traumatizing this very important and delicate part of your body.
Dr. Jeff Daniels has been practicing medicine in Big Sky since 1994, when he and his family moved here from New York City. A unique program he implements has attracted more than 700 medical students and young doctors to train with the Medical Clinic of Big Sky.