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Doctor’s Note: Corneal abrasion common source of eye trauma



By Jeff Daniels EBS Medical Columnist

Protecting your eyes is very important. In theory, we all wore special glasses or used other devices during the Great American Solar Eclipse to prevent the sun’s light from damaging our eyes, but a much more common source of injury is often neglected, and could lead to a painful episode, or even loss of vision.

Corneal abrasions, or trauma to the surface of the eye, happen all of the time. Although most commonly seen in work environments, like building a house or working with stone, everyone is susceptible, and something as innocent as rubbing the sweat off your brow can accidentally traumatize the eye.

The most sensitive part of the surface of the eye is the cornea, which is comprised of five clear layers of tissue that cover the iris and the pupil. The iris is the brown or blue muscular tissue that gives a person’s eyes their color, and the pupil is the black dot through which light passes to the retina. A scratch or abrasion of the cornea is very painful, and while often invisible, the white part of the eye, or conjunctiva, on either side of the cornea will react with hundreds of tiny blood vessels engorging with blood, producing a bloodshot eye.

Eye protection when exposed to anything that can make contact with the eye is very important, but it’s often inadequate. Many injured workers I treat mistakenly think that their sunglasses are going to protect their eyes. The fact that they are in the office with an eye injury certainly casts doubt on that theory! Inadequate eye protection leads to three major types of corneal injury.

The most common is when a fast-moving object strikes the eye. This will damage one or more layers of the cornea and can result in a gouge-like crater in the surface, or a line of injury. Oftentimes there are several spots of various shapes that are injured.

One injury that is very common and easy to diagnose is when a small mote of material, usually a piece of sawdust, lodges underneath and sticks to the undersurface of the upper lid. In this case, every blink, which is exaggerated when there’s pain, carves a tiny line out of the cornea. Removal of the foreign material is relatively easy—especially once some numbing drops are applied—but the pain will remain until the sawdust or pebble is completely removed.

An injury that’s less common and usually presents to the clinic a few days after it happens involves a piece of material hitting the cornea and sticking to it. Tiny fragments of stone flying off a chisel, or a metal fragment from a grinder, may not bounce off the cornea, and instead start to become enveloped by corneal tissue. These motes of material are smaller than the period at the end of this sentence and eventually become very irritating. Luckily, this injury can be easily treated with the right equipment.

It’s important to anesthetize the eye, and examine with a slit lamp, which greatly magnifies the surface of the cornea. Sweeping the undersurface of the upper lid easily removes an embedded particle that all the eyewash in the world won’t remove! Under high magnification, it’s easy to remove a particle stuck on the eye. And any corneal abrasion can be demonstrated with the application of fluorescein dye, which sticks to the scratched surface and glows in the dark under a black light.

Common treatment protocol is to remove any foreign material, and then let the eye heal. Metal fragments can sometimes cause rust to accumulate in the cornea, and this must be removed. Antibiotics are sometimes used to prevent infection, but are not always necessary. Wearing proper protection helps prevent future abrasions.

Dr. Jeff Daniels was the recipient of the 2015 Chamber of Commerce Chet Huntley Lifetime Achievement Award and 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 800 medical students and young doctors to train with the Medical Clinic of Big Sky.

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