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Article # 4102

Eye Emergencies

Heartily tightening nuts and bolts, working under a car on a lift, an auto mechanic's wrench slips. Suddenly, he feels a sharp pain in his eye and begins gushing tears. A woodworker finishes the table leg he just cut and turns, lifting his goggles to go eat lunch. His co-worker is starting to cut the tabletop. Suddenly he can't see and shouts, "Something hit my eye!"

Heard stories like these before? What safety pro hasn't? Two ophthalmologists and an occupational health nurse related incidents similar to these. There were 88,329 eye injuries reported to the Bureau of Labor Statistics in 1994. 13,143 were caused by chemical, 5,708 by parts and materials. Of 7,523 injured laborers studied by the Center To Protect Workers' Rights in Washington, D.C., 424 experienced eye injuries. A bystander's immediate reaction can be crucial to saving the sight of an eye-injury victim. This article will give pointers anyone can use to help save a co-worker's vision.

Responses depend on the type of eye injury and what facilities are available. However, there are some basics to eye emergency response. It's important the responder is aware of what caused the accident, so there aren't suddenly two victims, says Jennifer Lim, president of Longspeak, Colo., chapter of occupational Health Nurses, Inc. Figure out the trail of kinetic energy of the material that caused the injury. For example, if a chip of wood flying from a table saw caused the injury, shut off the machine.

The respondent should also beware of other environmental conditions. Airway circulation trauma has been known to occur in emergency situations when the person helping focuses on the injury, and is oblivious to signs of chemicals in the air, says Lim. Inform the emergency medical technicians or the doctor of the type of work the person was doing and describe the tools being used. Also give EMTs pieces of broken objects-such as a splinter of metal from a chisel struck by a hammer-which may have been the cause of the damage, or available material safety data sheets for chemical injuries, says Bernard R. Blais, M.D., president of Blais Consultants, Ltd., in Clifton Park, N.Y., and chairman of the American College of Occupational and Environmental Medicine's Eye and Vision Committee.

Reassurance is always a good idea, says Gilda Everett, a nurse-practitioner in Greenville, N.C. Tell the victim help is on the way and that they are going to be alright. If the responder has to go for help, the best thing to do is situate the victim first; irrigate the eye or lay them down. Then inform the victim and go for help, says Everett. In many cases, both eyes will have to be covered. One eye darting around will cause the other eye to move about and possibly make the injury worse, says Blais. But being in the dark may scare the victim. Quiet talking or constant physical contact, such as holding their hand or a hand on their shoulder, will help calm them, says Brian Connolly, resident ophthalmologist at Wills Eye Hospital in Philadelphia, Pa.

Eyes are intensely sensitive and delicate. Any effort to assist someone with an eye injury should be undertaken gently, says Connolly. Eye injuries that look and seem minor can turn serious if not treated properly. Right after examining an employee's eye, if the injury is not serious, is a good time to mention the benefits of sufficient eye protection, says Annette B. Haag, RN, Cohn, president of her own consulting firm in Simi Valley Calif. In fact, all 12 professionals in the medical field mentioned the best response is to prevent further injuries by reminding workers to wear the proper PPE. Ninety percent of all eye injuries are preventable, says Blais. " My first recommendation? Prevention!" says Connolly.

Injuries can be broken down into five categories: foreign particles, chemical, radiant energy, laser, and contusions. Foreign particles can be superficial bodies, perforating bodies, penetrating bodies, or abrasions to the cornea. The CPWR study shows that 69 percent of eye injuries are caused by particles in the eye.

A superficial body, such as fine dust or dirt, needs to be washed out thoroughly. Or, if it is visible, take it out using a cotton swab. The most important thing is to get the offending particle out as soon as possible. The longer a particle is in the eye, the more damage it can cause, says Blais. Before irrigating, clean the area around the eye of dust and dirt. Use a magnifying lens to find the foreign body, if necessary. But don't push on the eyeball to look. Rest your hand along the bones surrounding the eye and lift the eyelid up, says Haag.

If you used an anesthetic, make sure the employee is wearing safety glasses before allowing him to return to work, suggests Connolly. But another option, says Blais, is to use a short-acting anesthetic, such as proparacain instead of a longer-acting one like tetrocaine. Corneal abrasions may occur from foreign bodies, contact lenses irritating the superficial layer of the cornea, or even a fingernail scratch. The cornea has a lot of nerves, which make these injuries especially painful. Opening and closing the eye makes it worse, says Haag. If there's the possibility of a foreign body, irrigate it and remove it, says Blais.

Penetrating foreign bodies should not be removed or touched for any reason, says Lim. The best response is to ask the worker to lie flat or sit still and place a shield around the eye and object, and cover the other eye to stem movement, says Blais. Then call for medical assistance. Note that a shield and a patch are two different things, says Connolly. A patch is usually gauze or tape to keep the light out and the eye from blinking. It also puts pressure on the eye, a bad idea for most injuries. A shield is a hard plastic cover that doesn't put any pressure on the eye. It does keep out the sunlight and holds in the eye. A plastic cup, taped around the head, is useful as a shield for protruding objects. Cut a hole in the end of the cup if the object is too long, he suggests.

Perforating foreign body injuries require a delicate response. First, you have to know what you are looking for:
• The employee reports that something hit his eye, then he started tearing profusely and could not see;
• The eyeball looks misshapen, collapsed, or deformed, says Blais.
If any of these symptoms are present, the response is simple: Do not touch the eye. Certainly don't lift the upper lid. Have the person lie down, then call for immediate medical assistance. Get the victim to an ophthalmologist soon. This injury will require surgery, states Blais. A common metaphor among eye doctors, Connolly and Blais included, concerns grapes. A ruptured eye is like a grape; you peel back the skin, the insides fall out. It's difficult to get the seeds and the body of the grape back into the skin. Chemical injuries can be caused by acid, alkali, detergent, irritant, or radioactive materials. " The basic principle is not to worry about neutralizing the chemical in the eye-just dilute it as fast as you can," says Blais, who feels strongly that there are too many individuals losing their eyesight to preventable chemical injuries and inadequate immediate treatment at the accident site.

Chemicals caused 8,731 of all eye injuries reported to the BLS in 1994. Each type of chemical causes different injuries, but all are generally put into two categories: alkalis and acids, says Blais. Acid burns show instantaneously. Chemicals such as hydrochloric and sulfuric acids form a coagulum over the surface of the eye and will not allow further acid to penetrate deeper, he says. Alkali burns, however, happen more progressively. Ammonia and lime, two alkali chemicals, tend to form a sort of soluble soap in the tissue and sink into the tissues of the eye, says Blais. Detergents are a milder form of chemical eye injury, causing damage by inflammation or drawing water from eye tissues. All chemical eye injuries should be treated with immediate irrigation, preferably with a saline solution. This is where the first minute is extremely important. For alkali injuries, irrigate for 45 minutes (by the clock). For acids, 30 minutes. Don't rush the injured person to the hospital if eye wash stations are available, says Haag. Don't waste any time before irrigating the eye. Don't try to take out contact lenses. Let them flow out with the irrigating fluid. In some cases, the contact lens protects the eye against further chemical damage. Be aware that some injured workers can experience what is known as blepharospasm, when the eye closes tight, uncontrollably. Still attempt to irrigate the eye, says Blais. All too often, injuries become permanent when blepharospasm occurs because the irrigation solution may not reach under the eyelids. Chemicals could remain under the eyelids, injuring or irritating the eye further than the original splash or spill. This is especially a problem with alkali materials, as they will continue to penetrate deeper into the tissues of the eye, says Blais. He suggests a type of eye irrigation mechanism that actually fits under the eyelid and attaches, by a hose, to a water or saline source. Some workers may require an anesthetic with this tool. They are relatively new instruments but have proven to be effective, says Blais. Lightly patch the eye, remembering not to touch the eyeball, but apply pressure to the outer bone. The employee may find a cold compress soothing. Apply it lightly. Get the victim to an ophthalmologist immediately. Flash burns, not related to welding, such as ultraviolet rays from the sun can cause sharp pain. Photophobia (intolerance for light), inflammation, swelling, and tearing, says Haag. Have you ever been laying out in the yard reading on a summer day and afterwards experienced red stinging eyes? That's a flash burn, say Blais. To be sure, inspect the eye for a foreign body. If the person is wearing contact lenses, remove them. An ice compress feels especially soothing for someone with these burns. Get them to an ophthalmologist, who will tell the employee how to care for it over the next 24 hours, says Blais. Arc welder's flash is an especially tough one, because the symptoms don't show for 6-10 hours and the employee will feel like there is a foreign body in the eye. Welder's flash commonly occurs among people not welding but walking past a welder or working next to one, says Connolly. Symptoms include pain, photophobia, and blepharospasm. Apply cold compresses as necessary. Keep patch on it for 24 hours, says Connolly. As with other flash burns, a trip to the ophthalmologist is recommended.