Ocular injuries and management

We all need to protect our eyes from injuries. When we go outside, as well as in our working environments. Without eyes, we are visually impaired. So we require appropriate consideration of our eyes. Not just utilizing eyewear, need appropriate eyewear which is reasonable in the working environment. The Major important thing that to use eyewear always. It has been assessed that 90% of ocular injuries are preventable. Such a variety of organizations are giving eyewear to well-being, but few of workers are inconsiderate. They would prefer not to utilize or they are overconfident. The Occupational Safety and Health Administration (OSHA-United State Department of Labor) reported that eye injuries alone cost more than $300 million every year in lost production time, medical costs, and specialist pay (A).  According to the U.S. Agency of Labor Statistics, more than 20,000 working environment eye injuries happen every year.

The eye injury can happen in any spots, including home, workplace when playing sports. The most obvious presentation of ocular injuries is redness and pain. 10-20% of eye injury results in temporary or permanent vision loss.

The most common types of objects causing ocular injuries are:-

  • Wooden stick
  • Broken eye glass
  • Stone/Tools/Toys/Airgun
  • Pencil, Pen, Metalic wire, Sharp Instruments
  • Animal Horn
  • Cricket Ball
  • Firecrackers
  • Road traffic accident
  • Chemical burns

What are the causes of domestic (indoor) eye injury?

Close mechanical eye injuries are the most common type of ocular injury.  Injuries can happen at home or while you do your daily living activity.  Injuries with pen or pencil are quite common with children. Abusive behavior at home likewise one of the reasons for ocular injury.

Chemical injury: – Chemical burns represent potentially blinding ocular injuries and constitute a true ocular emergency requiring immediate assessment and initiation of treatment.  Chemical burns represent 7%-10% of eye injuries. Around 15%-20% of burns to the face involve at least one eye (B). The greater part of casualties are youthful and presentation happens at home, working environment and in a relationship with criminal attacks. Alkali injuries occur more frequently than acid injuries. Chemical injuries of the eye produce extensive damage to the ocular surface epithelium, cornea, anterior segment and limbal stem cells resulting in permanent unilateral or bilateral visual impairment. Early signs of the chemical eye burn are  Pain, redness, irritation, tearing, inability to open eye, foreign body sensation in the eye, swelling of the eyelids, blurred vision. Epithelial damage due to chemical injury causes corneal scar which is resulting in reduced visual acuity and contrast sensitivity of eyes. Complications of severe chemical burns can include corneal perforation, corneal ulcer, cataracts, glaucoma etc. 

Acid
SubstanceFound in
Sulfuric acisBattery acid, Industrial cleaner
Sulfurous acidBleach, Refrigerant, Vegetable and Fruit preservative
Acetic acidGlacial acetic acid, Vinegar
Hydrochloric acidChemical laborateries, Swimming pool
Hydro fluoric acidGlass polishing, Mineral refining, Gasoline alkylation , silicon production
 
 Alkali
SubstanceFound in
AmmoniaCleaning agents, Fertilizers, Refrigerants
LyeDrain cleaners, Airbags
LimePlaster, Cement, White wash, Mortar
Potassium hydroxideCaustic potash
Magnesium hydroxideFirework sparklers, flares, Incendiary devices
(C)

Severe chemical injury with early corneal neovascularization.
Severe chemical injury with early corneal neovascularization. P.C- Medscape
Complete cicatrization of the corneal surface P.C- Medscape
Complete cicatrization of the corneal surface        P.C- Medscape

Irritants: – Irritants are substances that may cause injuries to the skin, the eyes or the airways after a single exposure. They usually do not affect vision. These injuries may extend from small, initially invisible injuries after exposure to weak irritants up to chemical burns after exposure to very strong irritants (i.e. Corrosive substances). Most household detergents fall into this category. Soap, detergents, solvents, welding fume are fallen in this category. Irritants can cause significant pain but rarely causes any damage to the eye.

What are the causes of the eye injury at the workplace?

  • Flying objects (Bits of metal, Glass)
  • Tools
  • Chemicals (Splashes & fumes)
  • Harmful radiations (Especially visible light, UV radiation, lasers, heat or infrared radiation)
  • Bloodborne pathogens (Hepatitis and HIV) from blood and body fluids
  • Any combination of above
Occupation with high risk of eye injuries include
  • Construction
  • Manufacturing
  • Mining
  • Carpentry
  • Plumbing
  • Welding
  • Electrical work
  • Maintenance
  • Auto repair
The common eye injuries are-
Subconjunctival hemorrhages P.C-iytmed.com
Subconjunctival hemorrhages P.C-iytmed.com
 
  • Scratched eye (Corneal Abrasion)
  • Subconjunctival hemorrhages
  • Swelling of the eye
  • Traumatic Iritis
  • Hyphema
  • Orbital Blowout Fractures 
    Corneal abrasion P.C- improveeyesighthq.com
    Corneal abrasion P.C-improveeyesighthq.com
      There are 3 types of globe injury
  1. Open globe injury
  2. Close globe injury
  3. Adnexal injury

Open globe injury – Most of the open globe injuries are caused by the sharp objects. Corneal tear, Scleral tear or both conditions with the anterior chamber collapse are the common types of open globe injury. Delaying of treatments can lead endophthalmitis. Endophthalmitis is a condition where chances of losing vision or eye much more.

The ocular adnexal injury – It causes by either sharp instruments or severe thrust by a blunt object. Lid tear, conjunctival tears, canalicular tear with lid tear commonly seen in these types of eye injury.

Blunt injury – Blunt injury causing closed globe injury. It causes cataract, hyphema, angle recession, retinal detachment, vitreous hemorrhages and optic nerve avulsion.

Other types of eye injuries

Muscular Entrapment – Fracture of orbital bones can lead to paralysis of extraocular muscles. Restrictions of ocular movements.

Ultraviolet radiation hazards – Ultraviolet is a non-ionizing radiation and most common cause of radiation injury of the eye. The ozone layer in the atmosphere filters most of the ultraviolet rays. Human cornea absorbs most of the ultraviolet radiation. Ultraviolet (UV) rarely damage the cornea. Unprotected exposure to the sun, solar eclipses or highly reflective snow fields at high elevation can lead to direct corneal epithelium injury, which is called UV keratitis. There are several sources of UV radiation in the laboratory including germicidal lamps in biological safety cabinets, carbon arcs, photographic flood lamps, nucleic acid transillumination boxes, halogen desk lamp nucleic acid crosslinkers and UV lasers. Photokeratitis is a painful injury of the cornea due to exposure to UV radiation in the eye. Symptoms are irritation, foreign body sensation which the last up to 2 days. decreased visual quality after 6-12 hours of injury. Chronic exposures to acute high-energy UV radiation can lead to the formation of cataracts. Prolonged exposures to UV radiation can lead to chronic solar toxicity, which is associated with several ocular surface disorders (eg, pinguecula, pterygium, climatic droplet keratopathy, squamous metaplasia, carcinoma).

What to do in case of an eye injury?

To treat sand or small debris in the eye:-
  • Flush water in the eye until the debris doesn’t come out.
  • DO NOT rub the eye because corneal scratch, corneal epithelial erosions (SPE ) are commonly seen after the injury due to excessive rubbing of eyes.
  • Go to the doctor if debris or foreign body doesn’t come out.

To treat Chemical Injury: –  For all chemical injuries, the first thing you should do is immediately irrigated the eye thoroughly. Ideally, specific eye irrigating solutions should be used for this, but if none is available, then regular tap water will do just fine.

  • Wash your eyes immediately. Look down and wash it. Flush water 10-15 minutes continuously. Don’t put water if your eye has been cut or punctured.
  • If you are at home and do not have a special eye wash, step into the shower with your clothes on to wash out your eye.
  • Contact local doctors or hospital immediately. Patch the Eye with eye pad if possible or with clothes and go to the doctor.
  • If an alkali (e.g., drain cleaner) or hydrofluoric acid burn has occurred, continue washing until a doctor arrives or you have been taken to a hospital emergency department.

In case of cuts and punctures to the eye or eyelid

  • Do not wash out the eye.
  • Do not attempt to remove an object that is stuck in the eye.
  • Cover the eye with a rigid shield, like the bottom half of a paper cup.
  • Seek immediate medical care.

Remember

  • DO NOT rub or apply pressure to the eye
  • DO NOT try to remove the object stuck in the eye
  • DO NOT apply any medication or ointment
  • See a doctor as soon as possible, especially ophthalmologist

 When you need an immediate ophthalmologist consultation?

  • Foreign body doesn’t come out from the eye
  • Severe pain
  • Redness
  • Decreased vision
  • Photophobia
  • Double vision
  • Deep cut around the eyes
  • Blood visible into the eye
  • The eye is sticking out from the socket

What are the different kinds of eye protection to prevent ocular injuries?

An estimated 90% chemical eye injuries are avoidable. People need proper eye and face protection to avoid injury when working with hazardous materials or in a hazardous situation.
  • Safety glasses
  • Shielded safety glasses / Full face shields
  • Googles
  • Welding helmets
  • Full-face respirators

Safety glasses:-

Safety glasses may be prescription glasses or non-prescription glasses. Glasses should be used when there is minor dust, chips or flying particle because one small dust can cause scratching the eye which can leave a scar in the eye. Corneal scarring can reduce visual acuity. Sometimes small dust injury is the causes of microbial or fungal keratitis of the eye. These two diseases are the most sight-threatening condition of the eyes. Lens material may be plastic, mineral glasses, polycarbonate or trivex. Mineral glasses are not easily scratched, but heavy.  Mineral glasses can be used around chemical work environment. Glass can accommodate a large number of prescriptions. Plastic lenses are lighter in weight and protect against welding splatter. But plastic lenses are not as scratch-resistant as glass. Polycarbonate material is 10 times more impact-resistant than regular glasses or plastic lenses and more than 40 times of FDA’s requirement. Polycarbonate is the first choice for children eyecare practitioners. Trivex is the best choices for sunglasses, eyeglasses, and sports eyewear. Several cases a simple dust injuries turn into microbial or fungal keratitis, which is a major sight-threatening condition of the eye. Safety glasses must meet standards of the American National Standards Institute (ANSI). 





Goggles:-

Google provides the best protection against dust, sand, other flying objects and chemical splash. Safety goggles are highly impact-resistant. Goggles can be worn over the contact lenses and prescription glasses. As goggles have to shield around the eye, they protect hazards coming from any direction.

Shielded Safety glasses or Full face shields:-

Shielded glasses give better assurance from flying debris. Safety glasses additionally suggested for welding workers. It provides protection against chemical which suspended in the air. Full face shields offer full-face protection against spraying, chipping, grinding, chemical or Bloodborne hazards. They are available in tinted or metal-coated styles for heat and splatter protection. Because the curve of the face shield will allow particles or chemicals to come from the sides into the eyes, safety glasses or goggles must be worn under a face shield at all times. 




Welding helmets:-

It is essential for welders to protect eyes, face, and neck from flash burn, ultraviolet light, sparks, infrared lights, and heat while performing certain types of welding work. Each welder needs eye insurance while does welding work alongside welding caps or goggles. Welding filters are mounted in the helmet as a window.  Depending upon the type of welding, the spectacles or goggles also mount on helmets.  In most helmets, the window may be made of tinted glass, tinted plastic, or a variable-density filter made from a pair of polarized lenses. Welding helmets can prevent photokeratitis and retina burn which causes temporary or permanent vision loss. 





Full-face respirators:-

Respiratory protection is a key component in the range of personal protective equipment (PPE) essential for first responders and others in any scenario where there is exposure to chemical, biological, radiological and nuclear (CBRN) hazards. Alongside proper eyewear, respirators help provide the best protection from dust, chemicals, and smoke inhalation. They are available in full- or half -face styles. When half-face respirators are used, make sure that the respirator does not interfere with the proper positioning of the eye protection.

 Important ways to reduce your risk include:

  • Know your chemicals– check the chemical’s label and its Material Safety Data Sheet (MSDS) for information on safe handling. Strictly follow the manufacturer’s instructions.
  • Choose safer products– hazardous chemicals can occasionally be replaced with less toxic options, or you may be able to buy the same chemical in a less dangerous form. For example, a liquid product may also be available as pellets.
  • Wear the proper eye and face protection– Select the right eye protection for the work site. Make sure safety eyewear fits right and stays in place.
  • Keep safety equipment in good repair– safety goggles and face shields need to be replaced regularly. Check the manufacturer’s guidelines.
  • Don’t wear contact lenses– a contact lens may absorb the chemical and concentrate the burn on the eye surface. When working with chemicals, wear prescription glasses instead of contact lenses – and always wear protective equipment over the glasses.
  • Dispose of unwanted chemicals safely- Dispose of unwanted chemical regularly.
  • Use smart workplace safety practices- Always brush, shake, or vacuum dust and debris from hardhats, hair, forehead, or your brow before removing protective eyewear. Don’t rub eyes with dirty hands or clothing. Clean your eyewear regularly.

References:- 

A. https://www.osha.gov/SLTC/eyefaceprotection/ B. http://www.webmd.com/eye-health/chemical-eye-burns? C. http://eyewiki.aao.org/Chemical_(Alkali_and_Acid)_Injury_of_the_Conjunctiva_and_Cornea D. http://emedicine.medscape.com/article/799025-overview#a5  

Krishnendu Mandal
Optometrist, Blogger, Blogging since Jan 2016

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