Unfortunately, this is an area where many people fail to follow their doctor's advice. Treatments are not absolute, and follow-up care is necessary to ensure that the treatment prescribed is effective.
Depending on the severity of the injury, follow-up care for re-evaluation should be in 1-2 days with an ophthalmologist. Follow-up care after surgery varies widely depending on the procedure.
Eye protection is the best prevention. Many eye injuries, especially high-speed impacts that may rupture the globe (eyeball), are usually devastating to your eye and could result in vision loss. Always wear eye protection when working in an environment where flying debris is likely.
Eye protection should cover not only the front but also the side of your eyes. Regular sunglasses or corrective glasses are not sufficient eye protection when working in a high-risk environment. You should wear goggles or safety glasses with side shields.
The prognosis for corneal abrasions, even large ones, is very good. Most corneal abrasions heal within 48 hours. The prognosis for other eye abnormalities is often much less favorable. A ruptured globe (eyeball) often leads to total loss of vision, even with early intervention.
Retinal damage usually leads to permanent vision loss. Depending on the extent of the retinal damage, this vision loss could be partial or complete.
Depending on the nature of the injury and other associated injuries, damage to the iris may be repairable. Lacerations to the tissues around the eye are often repairable but can lead to varying levels of facial disfigurement.
Because of the specialized nature of eye examination equipment, a foreign body in your eye is usually handled best in your ophthalmologist's office. If an emergency department has the necessary equipment, your ophthalmologist may also see you in the emergency department after hours if necessary. In some cases, a foreign body in your eye may be handled in an emergency department that has both a properly trained emergency physician and the appropriate equipment.
The most important aspect in deciding to seek medical attention has to do with your own evaluation of the severity of the injury. A few guidelines should be followed in deciding to have your eyes evaluated. If you do not meet these guidelines, but you are concerned that there may be significant damage, then it is always safer to be evaluated by your ophthalmologist or in a hospitals emergency department.
You should be able to care for minor debris in your eye at home. If you have trouble removing something in your eye or if a larger or sharper object is involved, you should seek medical attention. If you are wearing a contact lens, it should be removed prior to trying to remove the foreign body. Do not put the contact lens back into your eye until your eye is completely healed.
For minor foreign bodies, such as an eyelash, home care should be adequate. Begin by rinsing your eye with a saline solution (the same solution used to rinse contact lenses). Tap water or distilled water may be used if no saline solution is available. Water will effectively flush out your eye, but the chlorine in most tap water can cause varying levels of irritation. How you wash out your eye is less important than getting it washed out with great amounts of water.
A water fountain makes a great eye wash. Just lean over the fountain, turn on the water, and keep your eye open. At a sink, stand over the sink, cup your hands, and put your face into the running water.
Hold a glass of water to your eye and tip your head back. Do this many times. If you are near a shower, get in and put your eye under the running water. If you are working outside, a garden hose running at a very modest flow will work. If washing out your eye is not successful, the object can usually be removed with the tip of a tissue or a cotton swab.
Pull back the eyelid by pulling down on the bottom edge of the lower lid or by pulling up on the upper edge of the upper lid. Look up when evaluating for a foreign body under the lower lid. Look down when evaluating for a foreign body under the upper lid. You will often need someone to help you in this case.
Be very careful not to scrape the tissue or the cotton swab across your cornea, the clear dome over the iris. For larger foreign bodies or metal pieces, you should seek medical care, even if you are able to safely remove them at home. If the foreign body is easily accessible and has not penetrated your eyeball, you may be able to remove it carefully with a cotton swab or a tissue.
If you have any question about penetration of the eye, do not remove the object without medical assistance. If you cannot remove the object or if you continue to have the sensation that something is in your eye even after the debris is removed, you should seek medical care. After the foreign body is removed, your eye may be red and tearing.
You may protect your eye by cutting the top part off of a Styrofoam or paper cup and placing the cup over your eye. If you place a cup over your eye, do not put any pressure on the injured eye, because it could cause additional injury to your eye.
This cup can be taped in place and will form a cover over your eye. It is very important not to rub your eye or to apply any pressure to your eye. If you have punched a hole in your eye (called a ruptured globe or eyeball), you can do significant damage by pressing or rubbing your eye. This is especially true with small children who will rub their eyes to try to remove the debris.
For scratches on your cornea (called corneal abrasions), the usual treatment is an antibiotic ointment and/or antibiotic eyedrops and pain medicine. If the abrasion is large (greater than 50% of the corneal surface), then it may also be treated with a patch. Any noted damage to the iris, the lens, or the retina requires immediate evaluation by an ophthalmologist and may or may not require surgery.
A ruptured eyeball requires surgery by an ophthalmologist. If no other injury is noted, hyphema (blood in between the cornea and the iris) requires close follow-up care with an ophthalmologist.
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