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 40 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 Massachusetts Eye and Ear Infirmary.

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:

• 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.
• Foreign bodies

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

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

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 (CT) scans.

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.