This summer, Mount Nittany Physician Group Occupational Health has been focusing on the cause, diagnosis, treatment and prevention of eye injuries. This month, we will highlight the most commonly seen eye injury: the corneal abrasion.
Most of the human eye lies within a protective bony structure. The exposed portion of the eye has protections such as the eyebrows and eyelashes that partially shield the eye from small particles, the eyelids, which close rapidly and reflexively when danger to the eye is sensed, and tears, which respond in an attempt to wash away any foreign bodies as well as lubricate the eye.
Another protective feature is the cornea. The cornea is a highly organized group of cells and proteins with three main functions: barrier protection, filtration of some ultraviolet wavelengths in sunlight, and refraction - or focus - of light on the retina. Although it is only about 1mm thick, the cornea has five distinct transparent layers, each with a slightly different function, but all offer layers of protection for the eye.
A corneal abrasion results from cutting, scratching, or scraping the thin protective clear coat of the exposed layers. These injuries, while usually relatively mild, can cause significant symptoms of pain, tearing, photophobia (sensitivity to light), foreign body sensation or a "gritty" feeling in the eye. Symptoms can be worsened by exposure to light, blinking and rubbing the injured surface against the inside of the eyelid.
These injuries often result from failure to use the proper protective eyewear when engaging in activities that place the eyes at risk. Examples in the workplace include welding, working with power tools, chemical handling, dust exposure, landscaping or working with patients where blood or body fluid splash is a risk. In the home environment, simple precautions such as clipping a baby's fingernails can avoid an inadvertent scratch to a parent’s eye. Wearing eye protection while lawn mowing or working in a home workshop is advisable.
The evaluation of a corneal abrasion first includes ruling out any underlying eye problems, ruling out the possibility of an imbedded foreign body and then identifying the abrasion.
When a corneal abrasion is confirmed, topical antibiotic drops to prevent infection, liberal use of artificial tears or moisturizers, and oral painkillers such as Tylenol or Ibuprofen are often recommended. Depending on the size of the abrasion and the mechanism of injury, it may be necessary to offer patients a 24-hour supply of pain medication for the severe pain associate with these injuries.
Fortunately, with the appropriate treatment, corneal abrasions typically heal very well and rarely have complications. Healing time depends on the size of the corneal abrasion. Most heal within two to three days, while larger abrasions that involve more than one half of the surface area of the cornea may take four to five days. In patients with traumatic corneal abrasions, symptoms may recur for up to three months.
The goal should always be rapid triage of any eye injury to the occupational health office to prevent delays in treatment. After hours, these patients should be treated immediately in the emergency department.
In any eye injury, rapid treatment is essential. An occupational health office can help triage the injury and prevent delay in treatment. If the injury occurred more than a few hours ago, patients should seek immediate treatment in an emergency department.
As always, prevention is the best protection. Here is a list of activities when eye protection (with side shields) should always be worn:
- Doing work that may produce slivers, particles, or dust from materials like wood, metal, plastic, cement and drywall
- Hammering, sanding or grinding
- Working with power tools
- Working with chemicals, ammonia or oven cleaners
- Using lawnmowers, riding mowers or other motorized gardening devises, such as weed whackers
- Welding, or "jumping" batteries - or being a bystander to any of the above
- Sports (paintball, racquetball, baseball, cycling, riding on/being a passenger on a motorcycle)
- Sun exposure- the corneas can suffer burns when exposed to the sun for prolonged periods such as falling asleep sunbathing with eye half open, which can cause serious corneal burns
The eyes are a precious gift that can never be replaced. We, at Mount Nittany Physician Group Occupational Health, encourage you to be mindful of the fragility of eyesight and take every opportunity to protect your eyes at home and in the workplace.