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Eye Injuries

  • Often caused by sports or other physical activity, eye injuries can be serious and are usually quite painful. They are also a common cause of vision loss in children. Eye injuries can range from corneal abrasions and chemical burns to bruising and having foreign bodies in the eye.

    • Approximately one-third of the estimated 2.4 million eye injuries that occur annually in the United States are in people age 17 and younger.
    • Males make up three-quarters of reported eye injuries.
    • About one-half of eye injuries occur in the home.

    For the more than forty years, the medical staff at Boston Children's Hospital's Department of Ophthalmology have examined more than a quarter of a million children with eye problems, more than 19,000 visits each year. Boston Children's physicians see patients at the following locations: Peabody, Lexington, Weymouth, Waltham, Sandwich and The Mass Eye and Ear Infirmary.

    Eye

     
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    Boston Children's Hospital
    300 Longwood Avenue
    Boston MA 02115

     617-355-6401


  • Is my child’s eye injury an emergency?

    Any injury to your child’s eye should be considered a medical emergency, and immediate medical care is necessary. Often, a younger child with an eye injury may need to be examined in the operating room under general anesthesia. Physicians who specialize in comprehensive eye care are called ophthalmologists and are usually involved in the care of children with eye injuries.

    What causes eye injuries?

    Eye injuries from sports are quite common.

    Some of the more recurrent eye injuries occur during the following activities:

    • hockey
    • archery
    • darts
    • BB guns
    • bicycling
    • sports that involve rackets
    • baseball
    • boxing
    • basketball

    Other common causes of eye injuries include:

    • chemicals
    • toys
    • fingernails

    Types of eye injuries

    There are many different types of eye injuries that require clinical care by a physician or other health care professional.

    Learn more about sports-related eye injuries. For information on symptoms for specific types of eye injuries, visit these sites:

    Types of eye injuries

    • Corneal Abrasions: A corneal abrasion is a scratch or injury to the cornea, the clear, dome-shaped surface that covers the front of the eye. This is a very common occurrence in children. There are many things that can cause an abrasion to the cornea. . When these objects make contact with the surface of the eye, a small abrasion can occur. The more common causes include:
      • foreign bodies in the eye (such as dirt, pebbles, insects)
      • a scratch from a toy or fingernail
      •  
    • Chemical burns: Chemical burns occur when your child gets any type of chemical in his or her eye. Chemical burns are a medical emergency, and your child should receive immediate medical care. Chemical burns can result in a loss of vision and even a loss of the eye itself, if not treated promptly and accurately. Household cleaning agents are a common cause of this type of injury.
    • Hyphema: This refers to blood in the anterior chamber of the eye. The anterior chamber is the front section of the eye's interior where fluid flows in and out, providing nourishment to the eye and surrounding tissues. A hyphema is usually caused by an injury to the eye, and blood is seen in the eyeball. This is a medical emergency, and immediate medical care is necessary.
    • Bruising or Black Eye (Ecchymosis): Ecchymosis, more commonly known as a "black eye," usually occurs from some type of injury to the eye, causing the tissue around the eye to become bruised. Your child's physician will examine the eye closely to make sure there is no damage to the actual eye itself.
    • Fractures of the orbit: The orbit is the bony structure around the eye. When one or more bones surrounding the eye are broken, the condition is called orbital fracture. An orbital fracture usually occurs after some type of injury or a strike to the face. Depending on where the fracture is located, it can be associated with severe eye injury and damage.
    • Eyelid lacerations: Eyelid lacerations are cuts to the eyelid caused by injury. Your child's physician will examine the eye closely to make sure there is no damage to the eye itself. An ophthalmologist may also examine your child for further evaluation of the eye.

    What are the symptoms of eye injuries?

    General symptoms of eye injuries can include:

    • blood in the eyeball
    • changes in the shape of the iris or pupil
    • eye pain
    • the absence of obvious symptoms

    How can my child prevent eye injuries?

    Eye injuries affect more than 1 million people every year, yet 90 percent of these injuries are preventable with the use of appropriate safety eyewear. Consider these reminders from Prevent Blindness America and discuss them with your child or teenager:

    At home or outside:

    • Wash your hands after using household chemicals; household products cause more than 32,000 serious eye injuries each year.
    • Wear chemical safety goggles when using hazardous solvents and detergents, and don’t mix cleaning agents around or near your child.
    • Turn spray nozzles away from your face and the faces of others.
    • Read and follow directions when opening bottle tops (such as wine or carbonated beverages).
    • Read and follow directions when playing games and operating equipment.
    • Provide lights and handrails to improve safety on stairs.
    • Keep paints, pesticides and fertilizers properly stored in a secure area.
    • Make sure you and your child wear recommended protective goggles, helmets and safety gear during the appropriate activities.
    • Use guards on all power equipment.
    • Protect your eyes from the sun, either by wearing a wind-brimmed hat or ultraviolet (UV)-protective sunglasses.
    • Never look directly at the sun, especially during an eclipse.

    At play:                      

    • Wear recommended protective eyewear during the appropriate sports and recreational activities.
    • Wear a helmet with a polycarbonate face mask or wire shield during the appropriate sports.
    • Handle fireworks with care.
    • Wear protective eyewear when using lawnmowers, as debris may be projected into the air.
    • Wear protective eye wear when performing science or lab experiments at school.

    Are cosmetics safe for my child’s eyes?

    According to the American Academy of Ophthalmology, cosmetics are among some of the most common sources of problems for contact lens wearers. Misusing cosmetics can lead to severe adverse reactions:

    • deposits on the lens
    • eye irritation
    • allergy
    • injury
    • infection
    • dryness

    How can my child use cosmetics safely?

    Make sure your teen abides by the following guidelines for safe cosmetics use:

    • Choose non-scented, hypoallergenic cosmetics manufactured by a well-known, trusted brand name.
    • Wash your hands before inserting or removing your contact lenses.
    • Apply make-up after inserting the contact lenses.
    • Don’t borrow cosmetics or lend your cosmetics to others.
    • Wash all make-up application brushes frequently.
    • Don’t purchase mascara refills in which you insert your old applicator.
    • Avoid frosted, pearlized, iridescent or other glittery types of eye shadow, which may contain ground oyster shells or tinsel.
    • Don’t apply eyeliner to the inner edge of the lid or above the lash line on the lower lid.
    • Avoid using loose powder on the face.
    • Don’t apply creams too close to the eyes.
    • Never apply eye makeup while in motion or while driving.
    • Don’t use water or saliva to lubricate an applicator or thin cosmetics.
    • Don’t apply cosmetics if your eyes are red, swollen or infected. If symptoms persist, an ophthalmologist should be called.

    Can the computer use cause eye strain?

    Eye strain may be attributed to prolonged computer screen viewing. Each child may experience symptoms differently, but the most common symptoms of eye strain are:

    • red, watery, irritated eyes
    • tired, aching or heavy eyelids
    • problems with focusing
    • muscle spasms of the eye or eye lid
    • headache
    • backache

    How can my child avoid eye strain when using a computer?

    The Occupational Safety and Health Administration (OSHA) recommends the following workstation modifications to help avoid eye strain:

    • Position the monitor or screen slightly further away than where you normally hold reading material.
    • Position the top of the screen at or slightly below eye level.
    • Place all reference material as close to the screen as possible to minimize head and eye movements and focusing changes.
    • Minimize lighting reflections and glare.
    • Keep the screen clean and dust-free.
    • Schedule periodic rest breaks to avoid eye fatigue.
    • Keep the eyes lubricated (by blinking) to prevent them from drying out.
    • Keep the screen in proper focus.

    You may also want to consult your child’s ophthalmologist, as some individuals who don’t normally need glasses may need corrective lenses for computer work.

  • How are eye injuries diagnosed?

    Some eye injuries go undetected because no symptoms are present. When an eye injury is suspected, a physician should be consulted. A physician can usually locate foreign matter in the eye by examining it with a magnifying glass under good light. If no foreign matter is present, your child's eyes and surrounding area will be examined to determine the presence and possible seriousness of an injury. During the examination, anesthetic eye drops may be administered to lessen eye pain.

    To help locate scratches and other small injuries, the eye is stained with an orange dye called fluorescein. This dye appears bright yellow under a blue examining light; with it, highlighted scratches and scrapes on the eye can be detected.

    More serious eye injuries may involve imaging studies such as x-ray or computerized tomography scans. For more information on how eye injuries are diagnosed, refer to the specific injury listed under Related Conditions and Treatments.

  • How are eye injuries treated?

    Treatment depends on the type of eye injury:

    Foreign matter

    Foreign matter in the eye usually requires only simple treatment. Blinking often forces sand or dust out of the eye, but a moistened cotton swab can also be used for removal. If foreign matter is embedded in the eye, treatment should not be attempted at home. Your child should be taken to the emergency room. A physician may apply surface antibiotics once the object is removed.

    Scratched cornea

    A scratched cornea usually heals without complications, but pain relievers and surface antibiotics may be prescribed. The treatment of cuts varies according to the extent of the injury. A small cut usually doesn't need stitches, but a severe cut to the eyeball requires immediate treatment and usually requires surgery.

    Chemical burns

    Emergency action is required when your child's eye has come in contact with chemicals. The affected eye should be immediately flushed with running water, and you should take your child to an emergency room. To ease the pain, a physician may apply a surface anesthetic. If eye damage is severe, surgery may be necessary.

    Eyelid lacerations

    If the laceration is simple, as determined by your child's physician, the cut will be sutured or stitched. Local anesthetic drops may be placed in the eye prior to the suturing, and the sutures will usually be taken out five to seven days after the injury.

    Sedation or general anesthesia may be needed for younger, uncooperative children. For larger lacerations, or if there is any involvement of the eye, an ophthalmologist may be consulted to evaluate and treat the wound.

    Hyphema (blood in the eye)

    Most children with hyphema should be treated in an emergency room. Treatment includes eye drops, a patch over the eye and avoiding activities like reading to prevent eye movement.

    Ecchymosis (bruised or black eye)

    Most black eyes heal completely and do not cause any damage to the eye. Treatment may include cold compresses to the eye for the first 24 hours, followed by warm compresses to the eye until the swelling stops. The child's head should be elevated to help decrease the amount of swelling.

    It's also important to know that the swelling and bruise may appear to spread and go down the cheek or to the other eye; this is normal. Consult your child's physician if the bruising and swelling does not resolve on its own.

    Fractures of the orbit

    Your child should consult with an ophthalmologist to decide on treatment. In some cases, treatment may be delayed to allow for the swelling and bruising to go down. Double vision should resolve without treatment within three to four days. In severe fractures, or if the eye is involved, surgery may be needed. See fractures of the orbit.

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