Open Wound of the Eye

First aid: what to do now

1. Call 911 or your local emergency number, or go straight to the ER.
2. Shield the eye. Tape a rigid shield over it, such as the bottom of a paper cup, resting on the bone around the eye. The shield must not touch the eyeball.
3. Do not press on the eye or rub it. Pressure can push the contents of the eye out through the wound.
4. Do not try to remove anything stuck in the eye.
5. Do not rinse a cut or punctured eye. Rinsing is only for chemical burns of the eye.
6. Do not apply ointments or drops.
7. Do not eat or drink, in case surgery under anesthesia is needed.
8. Avoid bending, straining or lifting. Keep the head raised. Ask for anti-nausea treatment if you vomit, because vomiting raises pressure in the eye.

Types of open eye wounds

• Corneal laceration: a cut through the clear front window of the eye. Partial-thickness cuts can sometimes be treated like a corneal abrasion, without surgery; full-thickness cuts need repair.
• Scleral laceration: a cut through the white of the eye, sometimes hidden under bloody swelling.
• Penetrating injury: an object enters the eye but does not exit.
• Intraocular foreign body: unlike a speck on the surface (foreign body in the eye), a fragment, usually metal, lodged inside the eye. This is classic after hammering metal on metal, and the entry wound can be tiny.
• Perforating injury: an object passes in and out of the eye.
• Globe rupture: the eye wall bursts from blunt force, often at weak spots.
• Eyelid laceration: a cut to the lid. Wounds through the lid margin or the inner corner may damage the tear drainage canal and need specialist repair.

Symptoms

• Pain, often severe, though small high-speed fragments may cause little pain
• Reduced or lost vision
• A visible cut on the eye or an object protruding from it
• A pupil shaped like a teardrop pointing toward the wound
• Bleeding into the white of the eye or into the front chamber
• Fluid leaking from the eye
• Swelling and bruising of the lids

Diagnosis

An emergency physician and an ophthalmologist examine the eye gently without pressing on it. Vision is checked first. A slit-lamp microscope shows corneal wounds; fluorescein dye may reveal leaking fluid (the Seidel test). A CT scan of the orbits looks for an orbital fracture and foreign bodies. MRI is never used when a metal fragment might be present.

Treatment

• Surgical repair as soon as possible, ideally within 24 hours, under general anesthesia. The surgeon closes the cornea or sclera with very fine stitches and removes foreign bodies.
• Intravenous and topical antibiotics to prevent endophthalmitis, a severe infection inside the eye.
• Tetanus booster if not up to date.
• Further surgery is often needed later for cataract, retinal detachment or scarring.
• Eyelid lacerations are repaired in layers, with a small tube placed in the tear duct if it is cut.

In the most severe injuries with no chance of useful sight, removal of the eye may be considered within the first weeks to reduce the rare risk of sympathetic ophthalmia, an inflammation that can attack the healthy eye.

Outlook

The outcome depends mainly on vision at presentation, the size and location of the wound, whether the retina is involved and whether infection develops. Small corneal wounds often recover good vision. Large wounds extending to the back of the eye have a poorer outlook. Regular follow-up with an eye doctor is needed for months.

Prevention

Most serious eye injuries are preventable with protective eyewear. Wear safety glasses or goggles rated ANSI Z87.1 for hammering, grinding, power tools, yard work and chemicals, and sports eye protection for racquet sports and paintball. Keep fireworks to professional displays and store sharp objects and BB guns away from children.

Frequently asked questions

What should I do if something cuts my eye?

Do not touch, rub, rinse or press on the eye. Cover it with a rigid shield, such as a cut-down paper cup, taped to the bones around the eye, and go to the ER immediately or call 911. Do not eat or drink in case you need surgery.

Can an eye heal from a cut on the eyeball?

Tiny, partial-thickness scratches heal on their own within days. Cuts through the full thickness of the eye wall need surgical repair. Many people keep useful vision after repair, but large wounds or infection can lead to permanent vision loss.

Should I remove something stuck in my eye?

No. If an object is stuck in or protruding from the eyeball, leave it in place. Removing it can cause the eye's contents to leak out. Protect the eye with a shield and get emergency care. Small loose specks on the surface can be gently rinsed with water.

How do I know if an eye injury is serious?

Signs of a serious injury include vision loss, severe pain, a visible cut, an oddly shaped pupil, blood inside the eye, fluid leaking or an injury from high-speed metal or glass. Any of these needs emergency care, even if the pain is mild.