A penetrating eye injury is an injury to the eye in which the wall of the eyeball is thoroughly damaged. There is a direct connection between the inside of the eye and the outside world and that can involve risks. Firstly, there is a risk of contamination of the interior of the eye with outside germs and secondly, there is the risk of the contents of the eye (vitreous humor) being squeezed out through the damage. When these conditions are not treated, it means irreversible blindness of that eye.
A common cause is a metal splinter that comes loose from a chisel. When hitting a chisel with burrs with a hammer, a piece of metal can be released and fired with the force of a projectile so hard as to pierce the outer very firm capsule of the eye. Other causes of eyeball puncture are, for example, darts, wind rifle balls and glass splinters after a (car) accident.
Symptoms of eye injury
Often the moment when an eye piercing occurs is clear. Something is hard against the eye and a small wound can be seen, often with blood and deformation of the pupil. Sometimes the causative agent is still clearly visible, stuck in the eye. It may also be much less obvious, because a hard firing metal splinter can only create a very small hole, which is barely visible. At the moment of piercing the eye, a small tap is felt. With proper examination, the small hole can often be detected and recognized by a blood stain around it. Vision is often greatly reduced by bleeding in the eye, but the pain is usually not too bad.
How does an eye injury occur?
A perforation of the eyeball usually occurs after something has hit with a lot of force. Metal splinters, which shoot off chisels or cutters, are a common cause.
Is it serious and what can you expect?
Perforation of the eyeball is a very serious condition in which the function of the eye is immediately compromised and should always be treated by an ophthalmologist. Treatment will consist of cleaning and stitching the wound. The severity of the injury and any infection will determine the chances of preserving that eye’s vision. The surgical treatment will almost always have to be done under anesthesia and you will have to be admitted for several days for the follow-up treatment.
When to see the doctor?
Always contact the general practice or the A&E (Emergency Department, formerly EHBO) of the hospital if you suspect a perforation of the eyeball. Sometimes the problem is immediately clear, possible complaints that can also indicate a perforation are:
- The feeling of a tap on the eye when working with metal or stone;
- Difficulty seeing with the eye;
- Pupils that differ in shape and size;
- Blood in the eye.
What can you do about it yourself?
You should always see a doctor if you suspect perforation of the eyeball. It is imperative not to put pressure on the eye. Do not try to remove contact lenses or anything else such as screws or nails from the eye. Do not put gauze on the eye, but keep a bowl, a plastic cup, or a cup over the eye and press it against the bone around the eye. Transport the victim in a semi-sitting or lying position and support the head. Do not use handkerchiefs to stop the bleeding from these wounds around the eye, but use sterile gauze.
General advice and precautions
Always wear safety goggles when working with metal, such as drilling, sanding, milling, or chopping, as well as driving nails. Provide good tools and also make sure that no people can walk across the lanes during darts and shooting matches. Do not let children play with air guns. Very notorious are injuries that occur during major garden maintenance. Always wear safety goggles when pruning, cutting, and mowing.
Source: Drs. W. van Donselaar
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