Eye Injury & Foreign Bodies

In 1989 I learned about eye foreign bodies and syncope on the same day. Driving with windows down past some road construction a bit of metal found one of my eyes. A few teary days later my folks brought me to a doc who splashed a couple miracle drops into the affected eye, then flicked out the metal and drilled out the rust. I was in high school with no previous needles or drills near my eyes, so it definitely had me on edge.

When the procedure was over I left the room, saw the tunnel, and awoke next to a toilet where I also learned about smelling salts. My eye healed quick, but my pride took a few more days.
Patients routinely find ERs with “something stuck” in their eyes. The large majority of these somethings are easily removed. Luckily, corneas heal remarkably fast. However, there are exceptions. Here are buzzwords for eye problems in general:

Red Flags:

• Lost vision (Blurry just from tearing and rubbing is not so concerning.)
• Direct blow from a small object (squash ball, paint ball, etc.)
• Past eye surgeries
• Possible rupture from high velocity projectile (metal striking metal, grinder use, shrapnel, etc.)
• Double vision
• Animal bite or scratch (particularly cat)
• Contact lens use (suspect infection)
• Fever
• Surrounding redness or pus
• Herpes/shingles lesions near the eye
• Chemical splash
• Persistent pain for multiple days
• Hyphema/hypopyon (blood or pus collection between iris and cornea)
• History of glaucoma, macular degeneration, detached retina
• Eye bulging out with associated infection or trauma (obviously)

Happy Words

• Normal vision
• “Got better after getting washed out.”
• “Pain is gone now. I just wanted to get checked… and can you fill out this workers comp form?”
• Seasonal allergies
• Eyelid infection (sty)
• Recent welding or high altitude sun exposure (hurts, but very likely to heal)

Sometimes the problem is due to infection, but often it’s from metal, dust, or just a simple scratch.
When you arrive tearing at the ER, step one will be to check your vision. You’ll squint and squirm your way through the exam. We’ll then drop either proparacaine or tetracaine into the affected eye, which seems to save the day 99% of the time. It stings initially, but then provides wonderful relief. If total relief then we’re comforted that the problem isn’t something deeper. (This is always part of my first aid kit. That said, beware overuse, as it inhibits healing and can increase the chance for further injury.)

With Flourescein strips we’ll then stain your eye orange. Using UV light this lights up abrasions, lacerations, foreign bodies, etc. At this point, dazzled family members sometimes get out cell phones for photos so patients can have a gander too.

If vision is ok, foreign bodies removed, and pain relieved after the topical medicine, we’re nearly there. If not, then we typically then refer to eye doctors for follow up. Unless, the globe is ruptured, retina detached or if other evidence for serious infection or trauma, it is extremely rare for the problem to require an eye doctor emergently. (As evidence for the rarity, I’ve only seen an ophthalmologist in an ER once in four years. And he was managing his own patient.)

Pre-R does not have a slit lamp for a great eye exam. However, if you need a hand with “something stuck” in your eye, give us a call. At the very least we have the miracle drops to take the edge off till you reach an ophthalmologist. We have a magnifier, flourescein strips, needles, eye wash and Q-tips as well, which are frequently sufficient. Eye patches too if you like. They aren’t standard of care, but some patients like the look.

However, no smelling salts. That’s old school.

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