For most of us, summer brings warmer weather, longer days, and a desire to get active outdoors. It’s the time of year for home repair projects that we’ve put off all winter, for maintaining the yard, and for participating in or attending sports events. There are quiet days of fishing, festive holidays celebrated with fireworks, and family vacations to the beach.
But the accoutrements and byproducts of these activities—from fishhooks to rocks turned into projectiles by a lawn mower to debris blown into your face on a windswept beach—can spell trouble for your eyes. In the United States, it is estimated that 2.5 million eye injuries occur annually, resulting in permanent vision loss to more than 50,000 people.1 While these statistics alone may be alarming, the life-altering effects of eye injuries are truly tragic.
A few years ago, while distributing food at a charity, I noticed the groundskeepers mowing the lawn on the playground. I turned to make sure there were no children nearby, only to be struck in the eye by a rock thrown from under the mower. The granite projectile flew more than 15 feet and through a galvanized metal fence before striking my right eye.
I was immediately transported to a nearby emergency department (ED), where I was evaluated by an ophthalmologist and diagnosed with a deep corneal abrasion, laceration of the lower lid, and blunt trauma to the globe. I was provided with antibiotic eye drops and instructions to follow up with an ophthalmologist.
Throughout my course of treatment, I carefully followed all instructions for care and recovered with only minimal vision loss. Although my subsequent clinical course could be termed “uncomplicated,” it was certainly more painful and frightening than I would have anticipated. So how can we help our patients avoid experiences like this?
Encourage Eye Safety
During office visits, promote eye health by reminding patients of safe tool- and chemical-handling principles to prevent injury to themselves and others. If they will be operating power tools or participating in recreational activities that could cause an eye injury, encourage the use of appropriate protective eyewear.2-4 For outdoor activities, wearing lenses that block 99% to 100% of UVA and UVB radiation, as well as high-energy visible (HEV) radiation (or “blue light”), is advisable.2,5
Get Prompt Attention
Teach your patients to seek immediate care if an injury does occur. Stress to your patients that prompt assessment of the injury and careful adherence to treatment and follow-up instructions is imperative to prevent or minimize vision loss.6
Emphasize basic care to your patients so they will know how to respond should eye injury occur. Penetrating injury to the globe is an immediate threat to the eye and requires emergent transport to the nearest hospital ED with ophthalmologist coverage.7 If a penetrating globe injury is suspected or observed, patients should be instructed to avoid pressure to or manipulation of the eye, stabilize intact a penetrating foreign body, and gently cover the injured eye with a loose shield to provide protection.6,7
Bony window injuries typically result from blunt trauma to the eye or cheek and should also be treated emergently, because of the likelihood of injury to the globe.8 Emphasize to your patients that if they are in doubt about the severity of an eye injury, an emergency evaluation is necessary.
Eye Injury Evaluation
in Primary Care
Although abrasions to the conjunctiva and cornea may be identified and treatment sought urgently at the time of injury, many patients with such abrasions will instead present to a primary care office days later.
When a patient seeks your care for redness, irritation, or suspected injury to the eye, a thorough health history should be taken, followed by an ophthalmoscopic examination, visual acuity testing, and fluorescein staining at a minimum. The history should include:
• When did the symptom(s) first begin?
• What activities was the patient participating in at the time the first symptoms were noticed?
• Was he/she wearing protective eyewear?
• What is the level of pain?
• Is he/she experiencing light sensitivity, visual changes, or discharge from the eye?
• Does the patient have any allergies?
• Does he/she wear contact lenses?
• Is there any significant past medical history?
It is helpful to know the patient’s pre-injury visual acuity to determine if there is new-onset vision loss. If so, he/she should immediately be referred to an ophthalmologist.
Following the evaluation of the health history and visual acuity, careful observation along the lash line, under the everted lids, and along the conjunctiva and cornea with an ophthalmoscope may reveal obvious injury or a foreign body. Pupillary abnormality—such as abnormal shape, hyphema, or hypopyon—warrants immediate referral. Small, retained foreign bodies that are identified on examination may be easily removed with gentle eye irrigation.