Eye Injuries. Eye Injuries. Chemical Conjunctivitis. Chemical Conjunctivitis. Eye. Anatomy Chemical Conjunctivitis

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1 Eye Injuries James A. Rochester, M.D. Medical Director WORKNET Occupational Medicine Eye Injuries Anatomy Chemical Conjunctivitis Blunt Trauma/Fractures Corneal Abrasions Foreign Bodies Welder s Flash Penetrating Trauma Eye Anatomy Chemical Conjunctivitis Chemical Conjunctivitis Chemical Conjunctivitis Irritation of the conjunctiva due to chemicals with neutral ph (ph=7) Solvents Detergents Vapors Fairly Sudden Onset Complain of irritation, itching, tearing No pain, No visual changes 1

2 Chemical Conjunctivitis If acute exposure Irrigate the eye If no significant injury on exam Symptomatic tx Lubricants (artificial tears) Appropriate Eye Protection Avoidance 7-10% of eye injuries Front structures of eye most affected Lids, Cornea, Conjunctiva More severe burns (alkali & hydrofluoric acid) deeper structures involved Iris, Lens, Sclera Acids Hydrofluoric (glass polish) Acetic (vinegar, nail polish remover) Sulfuric (batteries) Hydrochloric, Chromic, Nitric (common industrial compounds) ph less than 7 Alkali Ammonia (Solvents and refrigeration) Lye Potassium Hydroxide Magnesium Lime (plaster and cement) ph greater than 7 Pain Redness Irritation Tearing Inability to keep the eye open Sensation of something in the eye Swelling of the eyelids Blurred vision Treatment Lots and Lots and Lots of Irrigation 2

3 Prompt Ophthalmological Referral Potential for significant, long term problems Blindness Cataracts Glaucoma Loss of the eye Blunt Trauma to Eye Larger Objects Injury to bones around the eye Orbital rims, walls-roof roof-floor floor of the orbit Blunt Trauma to Eye Smaller Objects Injury to eye structures Cornea, lens, sclera, retina, muscles, nerve, vessels Blunt Trauma to Eye Protection is your best defense Proper protective eye wear First Aid Protect the eye Avoid direct pressure over eye or bones May consider protecting injured eye with shield Paper cup, Styrofoam cup Prompt medical attention needed Corneal Abrasions Clear outer layer Visual Axis Very Tough Very Thin Can Scar Problems with vision Corneal Abrasions Scratch of Cornea PAINFUL!! Something in my eye Risk for infection Risk for scarring Vision problems Antibiotics? Tetanus Booster Usually heal in 1-3d1 3

4 Foreign Body 2 Main Flavors Corneal and Conjunctival Metal: Rust Rings Risk for infection if not removed Foreign Body Corneal Rust Ring if Metal Removal Swab on surface Burr if imbedded Staining after removal Corneal abrasion Antibiotics? Tetanus First Aid Care? Foreign Body Conjunctival Usually Not Imbedded Flush eye or swab to remove Under lids can be tough to find and get out Usually no antibiotics First Aid Care? Welder s Flash Other terms Ultraviolet Keratitis of Cornea Arc Keratitis Slight burn (think sunburn) to the cornea from exposure of the eye to welding flashes w/o proper protection Welder s Flash Complain of significant eye pain Inability to tolerate light No visual disturbance No eye discharge Welder s Flash Exam Mild redness of the eye No other significant findings Staining may show faint punctate uptake Treatment Rest, avoid bright light, moisturizing drops, pain medication Resolves in days 4

5 Welder s Flash OSHA Standard Eye and face protection osha.gov/.gov/pls/oshaweb/owadisp.show_docu ment?p_table=standards&p_id=9778 Factors affecting minimum protective shade include Operation Performed Electrode Size Arc Current Call for EMS. DO NOT allow victim to touch or rub eye. DO NOT attempt to remove object. Cut hole in thick dressing or folded cloth. Place over BOTH eyes, with impaled object sticking out through hole. Position paper cup over injured eye and impaled object. DO NOT touch eye or impaled object. Secure cup in place with bandage or scarf that covers BOTH eyes. Eyes move together-cover both to keep injured eye from moving with uninjured eye Transport by EMS to Emergency Room as soon as possible 5

6 Questions? 6