Eye injuries

Page last reviewed: 13/07/2011

The structure of the face helps to protect the eyes from injury. Each eyeball is set into a protective socket of bone known as an orbit, and the eyelids can close very quickly to form a protective barrier.

Types of eye injuries

There are many types of eye injury. Some common eye injuries include:

  • corneal abrasions - damage to the cornea (the protective layer of transparent tissue at the front of the eye) caused by scratching or grazing
  • iritis (uveitis) - inflammation (swelling) of the iris (the coloured part of the eye that controls the amount of light that enters); it can be caused by a trauma to the eye (traumatic iritis), or by another condition (non-traumatic iritis) 
  • foreign bodies - material that accidentally gets into the eye, such as metal, wood, plastic or dust

How common are eye injuries?

Eye injuries are uncommon. For example, each year scratches or grazes to the cornea (corneal abrasions) affect about 3 in 1,000 people.

Corneal abrasions are usually caused by a foreign object getting into the eye, such as grit, or by a contact lens.

Superficial eye injuries

An eye injury is classified as superficial (affecting only the surface) if it does not penetrate beyond the Bowman's membrane. Depending on the size of the abrasion, a superficial eye injury will usually take between 24 to 72 hours to heal.

Eye injuries can be treated with eye drops to prevent infection, and oral analgesics (painkillers) to reduce pain.

Abrasion
An abrasion is an injury that happens when the skin is scraped off after it rubs against another surface.
Pain
Pain is an unpleasant physical or emotional feeling that your body produces as a warning sign that it has been damaged.
Structure
Structure is the way something is put together and how its different parts relate to each other.
Tissue
Body tissue is made up of groups of cells that perform a specific job, such as protecting the body against infection, producing movement or storing fat.
 

Structure of the cornea

The cornea is made up of five layers. Starting from the outside of the cornea and moving inwards, the layers of the cornea consist of the:

  • epithelium – a protective outer membrane that keeps the eye moist
  • Bowman's membrane – a thin layer of transparent tissue underneath the epithelium
  • stroma – a layer of connective tissue that supports the cornea
  • Descemet's membrane – a flexible, liquid-like layer that covers the inner surface of the cornea
  • endothelium – a single layer of thin, flat cells that form the inner surface of the cornea

Page last reviewed: 13/07/2011

Superficial eye injuries are minor eye injuries, but because the area around the eye bruises particularly easily, they can sometimes look worse than they actually are.

Corneal abrasions

Symptoms of a corneal abrasion include:

  • eye pain and sensitivity to light (photophobia)
  • increase in tears produced by the eye
  • blurred or distorted vision
  • squinting caused by spasm (involuntary contraction) of the muscle surrounding the eye
  • feeling that something is in your eye and it cannot be removed

Iritis (uveitis)

Symptoms of iritis include:

  • eye pain and sensitivity to light (photophobia)
  • deep ache in your eye, or in the brow region
  • small or irregular-shaped pupil
  • blurred vision
  • red, inflamed eye
  • increase in tears produced by the eye
  • headache

Foreign bodies

Symptoms of foreign bodies may include:

  • sensation that something is in the eye
  • increase in tears produced by the eye
  • eye pain
  • blurred or double vision
  • sensitivity to light (photophobia)
  • a visible foreign body on the cornea
  • a rust ring or stain on the cornea if the foreign body is metal

Other possible symptoms

Other symptoms of an eye injury can also include:

  • pain when you move your eye
  • burning sensation
  • swollen eyelids
  • a red spot of blood on the sclera (the tough white coating of the eyeball)
  • swelling and bruising around the eye

When to seek medical advice

Seek urgent medical advice if you have any of the following symptoms:

  • persistent eye pain
  • continuous bleeding from your eye
  • foreign bodies that cannot be removed
  • blurred and decreased vision
  • flashing lights, spots or shapes made up of shadows in your field of vision
  • redness in the eye, particularly around your iris (the coloured part of the eye that controls the amount of light that enters)
  • pain when exposed to bright light (photophobia)
  • a laceration (cut) to your eyeball or eyelid

Always seek medical attention if you sustain an eye injury as a result of an object hitting your eye at high speed.

 
Blood
Blood supplies oxygen to the body and removes carbon dioxide. It is pumped around the body by the heart.
Pain
Pain is an unpleasant physical or emotional feeling that your body produces as a warning sign that it has been damaged.
Swelling
Inflammation is the body's response to infection, irritation or injury, which causes redness, swelling, pain and sometimes a feeling of heat in the affected area.

Page last reviewed: 13/07/2011

Eye injuries have a number of different causes, such as:

  • a blow to the eye - from a blunt object, a sports injury, a fall or a fight
  • foreign bodies - any material that gets into your eye, such as metal, wood or plastic; the seriousness of the injury will depend on what the object is and whether it has pierced your eye
  • lacerations (cuts) - to the eyelids and eyeball
  • ultraviolet light (see below)

Eye injuries can also be caused by chemical exposures and burns as a result of liquid being splashed into your eyes.

Some aerosols can be harmful to the eyes, including Mace (attack defence spray), tear gas, pepper spray and some chemicals in hair spray. Chemicals can also be transferred from the skin on your hands to your eyes.

Blows to the eye

A blow to the eye can cause the following eye injuries:

  • Traumatic iritis - inflammation (swelling) caused by a blow to the eye from a blunt object, such as sports equipment or a fist.
  • Orbital blowout fracture - breaks or cracks in the bones of the face that surround the eye, which can push the eyeball further back into the eye socket (orbit).
  • Bleeding in the eye (hyphema) - can be caused by a blunt trauma to the eye, a sports injury, an industrial accident, a fight or a fall. 
  • Retinal detachment - a rare condition that can be caused from a blow to the eye, or a complication of diabetes called diabetic retinopathy. It can result from tears and breaks in the retina, and lead to permanent vision loss if not treated promptly.

See the Health A-Z topics about uveitis (iritis) and retinal detachment for more information about what causes these conditions.

Foreign bodies

Foreign bodies, such as metal, plastic or wood, can scratch or graze the cornea (corneal abrasion). Examples of foreign bodies that can cause a corneal abrasion include:

  • being poked in the eye by a finger
  • hot cigarette ash flying into the eye

Lacerations

A laceration (cut) can occur in the:

  • eyelids
  • conjunctiva - the clear coating that covers the outer surface of the eye and the inner areas of the eyelids
  • sclera - the cornea (transparent layer at the front of the eye) and the tough white coating of the eye ball

Eye lacerations can be caused by:

  • falls
  • contact with sharp objects
  • blunt trauma caused by flying objects

Ultraviolet light

Ultraviolet (UV) light can lead to an eye injury called ultraviolet keratitis or corneal flash burn. Exposure to the sun and sun lamps can cause of this type of injury. 

Contact lenses

Wearing contact lenses incorrectly can also cause injury to your eyes.

Corneal abrasions (scratching or grazing of the cornea) are likely to occur if your contact lenses are not clean, do not fit properly or are worn for long periods of time.

It is also possible for a foreign body, such as a tiny particle of dust or dirt, to become trapped behind your contact lens and cause irritation to your eye.

Page last reviewed: 13/07/2011

You should visit your GP or go to the Emergency Department (ED) of your local hospital if you have an eye injury that was caused by an object hitting your eye at high speed, such as a stone being thrown up from a lawn mower, or a piece of grit entering your eye while hammering or chiselling.

The healthcare professional treating you will ask you about your symptoms and how the injury occurred. They will also examine your eye in order to assess the extent of your eye injury. If your eye is painful, anaesthetic eye drops may be used to numb your eye before examining it.

Eye examination

During the eye examination, your eye will be checked for a scratch or graze (abrasion) and for the presence of a foreign body, such as grit or dust.

If you have an abrasion on the outer layer of your eye (cornea), the healthcare professional who is examining you may put eye drops that contain a special dye called fluorescein into your eye. The eye drops will stain any damaged areas of your cornea bright green, making them easier to see. A cobalt-blue filter may also be used to show up any abrasions.

If the healthcare professional thinks that you may have a foreign body stuck in your eye, they may gently turn your eyelid inside out and examine your eye using a magnifying glass.

As part of your eye examination, you may be asked to look around in all directions. This is to check whether there is any damage to your extra-ocular muscles, which connect your eyeball to your eye socket (orbit) and control your eye's movements. You may also be asked to blink several times to check if your eyelids are working properly.

The healthcare professional who is examining you may also shine a light into each of your eyes to assess the contraction of your pupils, which should become smaller when the light is shone into them. In some cases, a slit lamp (a lamp that emits a narrow beam of intense light) may be used to check for any damage to your eye that may otherwise be difficult to see.

To test the sharpness of your vision, you may be asked to read letters of various sizes from a wall chart. This is known as a Snellen chart, and is the same test that you may have during a routine eye examination.

X-rays(where pictures of the inside of the body are taken using small doses of radiation) are rarely used to diagnose eye injuries. However, if it is thought that a foreign body is stuck in your eye, an X-ray or a computerised tomography (CT) scan (a scan that produces more detailed images) may be recommended.

Ruling out other eye conditions

If your eye is red, other conditions which can cause this will need to be ruled out. Mild conditions that can cause redness in the eye include:

  • bacterial conjunctivitis - a common eye infection that is caused by bacteria
  • subconjunctival haemorrhage - bleeding into the whites of your eyes that is caused by burst blood vessels
  • ultraviolet keratitis - inflammation (swelling) of the cornea that is caused by ultraviolet light, such as from a sun bed

Some of the more severe conditions that can cause redness in the eye include:

  • acute glaucoma - a painful condition that causes pressure in your eye and affects your vision
  • orbital cellulitis - a bacterial skin infection that can spread to your eyes 
  • iritis (uveitis) - inflammation (swelling) of the uveal tract of your eye (a group of connected structures inside your eye, including the iris)

If your GP, or another healthcare professional who is treating you, thinks that you may have any of these conditions, they will refer you to an ophthalmologist (a specialist in treating eye conditions) for further assessment and treatment.

Page last reviewed: 13/07/2011

Self-help

If you have something stuck in your eye (a foreign body), or if your eye has been exposed to chemicals, you should wash your eye out using clean water, or a sterile fluid from a clear container. This will remove any loose material in your eye.

Flushing your eye

If chemicals are involved in the eye injury, flush your eye thoroughly using clean water or sterile fluid for at least 10 to 20 minutes. Use a lot of water to wash your eye, and gently hold your eyelids open throughout the rinsing process.

To flush your eye, you should:

  • stand over a sink, cup your hands and put your face into the running water
  • hold a glass of water to your eye and tilt your head backwards (do this repeatedly)
  • if you are near a shower, wash your eye out under the running water (this is particularly useful is your eye has been exposed to chemicals)
  • if you are working outside, you can use a garden hose to rinse your eye, but make sure that it is not on a powerful flow setting

Do not remove anything that is embedded in your eye.

Cover the injured eye with a clean pad and go straight to your nearest accident and emergency (A&E) department at your local hospital.

The way that eye injuries are treated will depend on the extent of the injury, the symptoms and, in some cases, how the injury was caused. Infections from eye injuries are rare. However, eye infections can be severe, so it is likely that antibiotics will be prescribed in order to help prevent infection (see below).

Referral to an eye specialist

You will need to be referred to an ophthalmologist (a specialist in eye conditions) for specialist treatment if:

  • your injury was caused by a small, high-speed foreign body, such as a stone thrown up by a lawnmower
  • your injury was caused by chemicals getting into your eye
  • there is a foreign body in your eye that cannot be removed by your GP
  • you have severe pain in your eye and/or your vision is severely affected
  • there may be damage to your retina (the light sensitive layer at the back of your eye)
  • you have a deep cut in your orbit (eye socket)
  • your eye injury becomes worse or shows no improvement on a daily basis
  • you have had recurring eye injuries

Removing a foreign body

If there is a foreign body in your eye, such as a piece of grit, your GP or a doctor at the accident and emergency (A&E) department of your local hospital, may try to remove it. They will put anaesthetic eye drops in your eye first in order to numb it and prevent any pain.

The foreign body may be stuck underneath your upper eyelid, particularly if you can feel something there, or if you have scratches or grazes (abrasions) on the top half of your cornea (the transparent outer layer of your eye). If this is the case, it may be necessary to gently turn your eyelid inside out to remove the foreign body.

Once the anaesthetic eye drops have worn off, your eye may feel a bit uncomfortable until the abrasion heals. You may also be given antibiotic eye drops (chloramphenicol) to use for five days. This reduces the risk of infection.

If the cells that line the outer surface of your eye (epithelium cells) are damaged, you may be prescribed eye drops (cyclopentolate) that prevent pupil spasm (involuntary contraction) and give the cells time to heal. However, cyclopentolate is not usually recommended for women who are pregnant.

Treating eye pain

If your eye is painful, analgesics (painkillers) may be recommended in order to help reduce the pain. This will usually be in the form of paracetamol or ibuprofen.

However, ibuprofen should not be taken if you have certain medical conditions, such as asthma. Aspirin should not be given to children under 16.

Do not take aspirin for pain relief if your eye is bleeding because this will increase the risk of bleeding.

Preventing infection

In order to prevent infection in your eye after an injury, you may be prescribed a course of eye drops and ointment containing an antibiotic called chloramphenicol. Most people will need to take the eye drops four times a day and use the ointment at night before bedtime, for seven days.

However, you may not be able to take chloramphenicol if:

  • using eye drops four times a day is not possible for you, for example, it interferes with work  or school
  • you are pregnant or breastfeeding (or if you are trying to get pregnant)
  • you, or someone in your family, has had a condition that affects the components of your blood, such as aplastic anaemia (a lack of iron in the blood caused by toxins)

If you cannot take chloramphenicol eye drops, you may be prescribed eye drops that contain fusidic acid. These should be used twice a day for seven days.

If you usually wear contact lenses, you should not do so until your eye injury has completely healed. This is because some of the ingredients in eye drops can build up in the contact lens and cause irritation. If you are prescribed antibiotic eye drops, do not start wearing your contact lenses again until 24 hours after finishing your treatment.

If there is a large corneal abrasion present, you may be treated with eye drops (cycloplegia) as they can also prevent an eye spasm (involuntary contraction).
 
Using eye patches to cover a corneal abrasion is no longer recommended. This is because it does not reduce the healing time or reduce pain.
 
Treatments for iritis include:

  • mydriatic eye drops - these dilate (widen) the pupil to help the eye heal
  • steroid eye drops - these help to reduce the inflammation (swelling) of the iris (the coloured part of the eye)
  • steroid tablets or steroid injections to the eye may be recommended in severe cases of iritis when eye drops have not been effective

See Health A-Z page on Treating uveitis for more information about treatment options.

Surgery

If you have a laceration (cut) on your eye, depending on the size of the injury and where it is on your eye, stitches and surgery may be required.
 
If you have an injury involving a crack or break of the bones surrounding your eye (an orbital blowout fracture), surgery will usually be performed one to two weeks after any swelling has gone down.

Follow up

In most cases, corneal eye injuries will heal within 24 to 72 hours. You will need to return to your GP after 24 hours of your initial treatment so that they can check that your eye injury is healing properly.

Your eye will be re-examined using fluorescein eye drops, which stain any abrasions bright green so that they are easier to see. If your eye injury has started  to heal, you will need to return to your GP daily until it has healed fully.

However, if your eye injury has not started to heal after 72 hours, or if it has got worse, your GP may refer you to an ophthalmologist (eye specialist) for further specialist care.

 
Anaesthetic
Anaesthetic is a drug used to either numb a part of the body (local), or to put a patient to sleep (general) during surgery.
Antibiotic
Antibiotics are medicines that can be used to treat infections caused by micro-organisms, usually bacteria or fungi. For example amoxicillin, streptomycin and erythromycin.
Antiseptic
Antiseptic is a substance that reduces the growth and development of germs.
Blood
Blood supplies oxygen to the body and removes carbon dioxide. It is pumped around the body by the heart.
Numb
Numbness refers to a lack of sensation in a part of the body.
Swelling
Inflammation is the body's response to infection, irritation or injury, which causes redness, swelling, pain and sometimes a feeling of heat in the affected area.
 

Page last reviewed: 13/07/2011

Most eye injuries are not serious, and will heal within 24 to 72 hours without any lasting damage. But complications sometimes occur, such as:

  • infection
  • recurring eye injuries
  • worsening symptoms

These complications are briefly discussed below.

Infection

Although infections following an eye injury are rare, they can be serious and severe, and will need to be treated with antibiotics.

Recurring eye injuries

In some cases, your eye may become injured again following an initial injury. This usually occurs at night when your eyes are less moistened by tears.

If your eye is dry, the outer layer of your cornea (epithelium) can disconnect from the rest of your eye.

Worsening symptoms

Sometimes, the symptoms of an eye injury can get worse.

For example, a foreign body that is stuck in your eye, such as grit, may start to penetrate or embed itself into your cornea (the transparent layer at the front of your eye).

It is also possible for a bruise to form in your eye, or for a foreign body to damage your eyelid. This is why it so important to seek immediate medical attention if you have an eye injury.

Page last reviewed: 13/07/2011

Many eye injuries are preventable if you take appropriate safety precautions. The advice listed below can help reduce the risk of sustaining an eye injury.

  • When using household products, such as cleaning fluids and bleach, always read the labels carefully, work in a well-ventilated area, and make sure that any spray nozzles are pointing away from you before spraying.
  • Wash your hands thoroughly when you have finished and make sure you do not rub your eyes if you have been handling cleaning fluids.
  • Wear safety goggles while using garden equipment, such as lawn mowers, to keep your eyes safe.
  • Take care when inserting or removing contact lenses. Follow the directions for keeping them clean and sterilised, and avoid wearing them for long periods of time. Never sleep with your contact lenses in.
  • Avoid looking directly into the sun. When outdoors on sunny days, wear a good-quality pair of sunglasses to protect your eyes from harmful ultraviolet light.
  • Cover your eyes if you use a sun lamp
  • Avoid rubbing your eyes

Safety at work

To reduce the chances of eye injuries happening at work, always ensure that you follow health and safety guidelines. For example:

  • wear safety glasses or goggles when using power tools, such as drills or saws, when using a hammer, and when mixing or spraying chemicals
  • always make sure that you wear the appropriate safety eyewear for your occupation. For example, if using an arc welder, wear an approved face mask to prevent sparks entering your eyes

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Content provided by NHS Choices www.nhs.uk and adapted for Ireland by the Health A-Z.

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