Article Contributed by Dr. Arshia Matin  and Dr. Vinay Nangia

Eyes are a beautiful creation of GOD and are placed in a well-protected position in the bony socket, further shielded by the eyelids and the eyelashes. This is the inherent protection of the eyes.

Besides all these safety measures provided naturally to us, the eye is exposed to many risks. Eyes can be injured in a variety of ways; by chemicals, heat, radiation, electric-current and mechanical trauma.

Alkalis:
Injuries by caustics such as lime usually occur from fresh mortar or whitewash entering the eye or from laboratory alkalis. These cause considerable damage to the eye. The colours used during ‘Holi’, if inadvertently put into the eyes, can cause irritation and foreign body sensation in the eye.
Immediately after the accident there is intense conjunctivitis and ulceration of the cornea.
Chemically injured eyes become fiery red and edematous.

Acids:
Acids like hydrochloric and sulphuric acid coagulate the surface layers. Laboratory staff and personals handling car and inverter batteries should be careful while at work.

Management:
Every precaution should be taken while handling these chemicals.
Immediately after the injury, the eye should be washed with copious amounts of clean water for at least half an hour to wash away all the chemicals.
The eye-care specialist should be consulted at the earliest as delayed.

Mehanical Injuries

Mechanical injuries are broadly divided into two categories:

• Open-globe: full-thickness defects in the coats of the eye. It can be secondary to severe blunt trauma or caused by sharp objects resulting in a laceration.
• Closed-globe: ocular injury without a full thickness defect of the coats. It usually follows blunt trauma such as caused by a cricket ball.

Superficial Foreign Bodies:
These are generally small particles of dust or steel, which may impinge upon the conjunctiva or cornea. They cause sudden discomfort and reflex blinking. It may be washed away by tears but at times can be lodged in the eye causing immense discomfort. If not removed they expose the eye to the dangers of infection by organisms in the conjunctival sac and resultant ulceration of the cornea. Therefore foreign bodies must be removed and managed as soon as possible by an ophthalmologist.

Prophylactic Measures:

Foreign bodies in the eye are extremely common in industrial workers, especially in those working with grinding tools, lathe work, or hammering on a chisel. Apart from endangering the sight of a worker, there is great economic loss due to expenditure of time and compensation. Such accidents can be prevented by the use of goggles and fitting of guards on machines for grinding.

Blunt Trauma:

Injuries by blunt objects vary in severity from a simple corneal abrasion to rupture of the eyeball. Every part of the eye may be so injured as to seriously diminish vision.

Penetrating Injuries:
Sharp instruments cause these. All are potentially serious and should be treated as emergencies.
The patient should immediately have an eye-shield applied and be thoroughly examined under general anaesthesia. Evaluation for repair is done at the same time.

Treatment:

All injured eyes must be carefully examined by an expert eye-specialist using modern equipment.

Repair of the eye is done with fine sutures using micro-surgical techniques under an operating microscope in a fully furnished operating room.

Following initial repair, subsequent surgeries may be required.
Modern techniques and equipment have helped in achieving a good visual outcome if timely intervention and care is provided.

Penetrating wounds with retention of foreign bodies:

The retention of a foreign body adds considerably to the danger of a penetrating injury. The foreign bodies most likely to penetrate and be retained in the eye are minute chips of iron or steel (accounting for 90% of foreign bodies in industry), stone, and particles of glass, lead pellets, and spicules of wood. A foreign body entering the eye may cause damage in one of the three ways:

• By mechanical effects
• By introduction of infection
• By specific action (chemical or otherwise) on the intraocular tissues.

Treatment:
A foreign body should be removed using microsurgical techniques by a well-trained eye-surgeon.

Conclusion:

Any injured eye, however trivial the injury may seem, needs immediate and urgent attention by an ophthalmologist. The earlier the injury is attended, better is the visual outcome.