Eye injuries

Chemicals in the eye need irrigating immediately, before anything else and before travelling. Minutes decide whether sight is kept.

What it is

Injuries to the eye and surrounding structures, from minor foreign bodies to sight-threatening trauma.

**Chemical injury is the one where action in the first minutes decides the outcome.** Alkalis, found in cement, plaster, oven cleaner, drain cleaner and dishwasher tablets, penetrate the eye and keep burning; acids are damaging too. The treatment is immediate, prolonged irrigation with any clean water available, for at least 20 minutes, before travelling to hospital, not after arriving. Delaying irrigation in order to get to A and E faster is a common and costly mistake.

**A penetrating injury**, where something has gone into the eye, is the other true emergency. The eye must not be pressed, rubbed or washed out, and nothing should be removed. Cover it with a rigid shield, not a pad, and go to A and E.

Blunt injury, a squash ball or a fist, can cause bleeding inside the eye, a blowout fracture of the orbit, or retinal detachment, and always needs examining even if vision seems normal.

Corneal abrasions and superficial foreign bodies are common, extremely painful and usually heal well within a day or two.

Most eye injuries are preventable with proper eye protection, and DIY, grinding, strimming and hammering metal are the classic circumstances.

Signs you might notice

Pain, watering, redness, and a sensation of something in the eye.

Blurred or reduced vision.

Sensitivity to light.

Blood visible in front of the coloured part of the eye.

An irregular or oddly shaped pupil, which suggests a penetrating injury.

Double vision, or difficulty moving the eye, which suggests an orbital fracture.

**Immediately, for chemicals: irrigate with clean water for at least 20 minutes, holding the lids open, then go to A and E.** Take the container with you.

**A and E now** for: any penetrating injury; anything that has gone into the eye; any blunt injury with reduced vision, blood in the eye, or double vision; and any injury from hammering or grinding metal, where a tiny fragment may be inside the eye even if the eye looks normal.

Do not remove anything embedded, do not rub, and do not apply pressure.

How it can affect day-to-day life

The prevention message is specific and unglamorous: proper eye protection for DIY, grinding, strimming, hammering, and handling chemicals. Ordinary glasses are not eye protection.

High-velocity fragments from hammering or grinding can enter the eye with almost no symptoms, and people go home and lose the eye. Anybody with an eye complaint after metalwork needs imaging, and saying what they were doing is the crucial detail.

Contact lens wearers with a painful red eye should remove the lenses and be seen promptly, because of the risk of a corneal ulcer, which can be sight-threatening.

Children's eye injuries are common from air weapons, elastic cords, sticks and darts, and the injuries are often serious.

Superglue in the eye is common and is usually managed well by eye casualty rather than by trying to unstick it.

After any injury, follow-up matters: retinal detachment and glaucoma can develop weeks or years later.

Supporting someone well

For chemicals: irrigate first, for at least 20 minutes, with any clean water. Do not travel first. Take the container.

For a penetrating injury: do not press, rub, wash or remove anything. Shield the eye with something rigid and go to A and E.

Say what you were doing, especially hammering or grinding metal; it changes the investigation.

Do not use anaesthetic eye drops repeatedly; they delay healing and mask damage.

Remove contact lenses for any painful red eye and get seen.

Wear proper eye protection for DIY, power tools and chemicals.

Get any blunt eye injury examined, even if vision seems fine.

Attend follow-up; some complications appear much later.

Where to get help

A and E or an eye casualty department immediately for anything beyond a minor foreign body.

999 for major trauma or a penetrating injury with other injuries.

An optometrist or minor eye conditions service, where available, for minor foreign bodies and abrasions.

RNIB helpline: 0303 123 9999 for support after sight loss.