Eye injuries: causes and prevention
Accidents do not just happen they are caused.
Health promotion, to prevent eye injuries, can be achieved by raising community awareness and involvement.1 It is a challenge to all eye health workers who may, consequently, make a significant contribution to the prevention of eye injuries.
Where and when do accidents happen?
The situations in which accidents commonly occur fall into five categories:
- In the home
- At work
- Leisure activities, e.g., sport
- At school and play
- Civil disturbances
1. The majority of accidents happen in the home environment, e.g., when doing home repairs, cooking or gardening. In developing countries it is common for women to injure themselves when chopping wood. Seasonal activities such as fruit picking, e.g., prickly pear, can cause injury. In the industrialised world, domestic equipment, such as microwave ovens have been the cause of facial and severe eye injury when liquids have ‘exploded’ when being removed from the oven too soon.2
2. The workplace (occupational accidents) is an environment often said to be ‘just waiting for accidents to happen’. Agricultural workers are prone to injuries due to flying objects (from ground and trees when cultivating the land with a hoe or traditional tools), faulty machinery and hazardous materials, e.g., fence wire and sharp implements used in the course of a day’s work.
The following occupations are also particularly vulnerable to eye injury at work:3
- Machine operator
- Construction worker
- Metal worker: cutting, drilling, grinding, welding, hammering, polishing
- Military personnel
Eye health care workers can also be at risk and are encouraged to wear eye protection in operating theatres to prevent contamination by splashes from patients’ infected body fluid, especially where there is a high prevalence of HIV and AIDS. In Italy, there is a reported case of a nurse contracting HIV through a splash to her eye.4 Orthopaedic operating theatre staff and dentists are also at risk when bone drills are in use.
3. Leisure and social activities also contribute to accidents. Too much alcohol can result in aggression and injuries to the eyes. Sport injuries are on the increase despite encouragement to wear protective clothing and accessories. Sports where there is potential for eye injuries include:
- Bungee jumping
- Racquet sports: tennis, squash, badminton
There is extensive literature on the subject of sport-related eye injury but the incidence varies considerably from country to country.
In many countries driving is also a leisure activity and has claimed many accident victims – drivers, passengers and pedestrians. Eye injuries as a result of shattered windscreens have been enormously reduced in the UK since the wearing of car seat belts became law in 1983.6 However, there is much debate about the use of airbags, now included in many models of cars, with the aim of reducing impact chest and facial injuries but which have been found to cause various eye injuries.7
4. Children, while at school and at play are frequent eye injury victims, due to slingshots, sticks, stones, toy guns and pistols. Often it is the innocent onlooker who is injured. A high number of penetrating eye injuries in children result from perforation of the cornea by a pencil.
5. In developing countries, civil unrest has been responsible for an increase in eye injuries in recent years. In Nigeria, for example, there has been a reported rise in ocular gunshot injuries.8 In Jerusalem, the West Bank and Gaza, rubber or plastic bullets were the leading cause of visual loss and enucleation in the period 1987-1993.9
What are the causative agents of eye injuries?
The following list of reported agents of eye injury is intended as a useful tool in raising awareness in the community. It does not matter how many accidents have been caused by each of these agents but each should be known as potentially dangerous.
- wood and splinters
- furniture comers
- glass and plastic
- shattered spectacles
- hard contact lenses
- umbrella spokes
- fish hooks
- tuning forks
- wire coat hangers
- blades and knives
- pens and pencils
- loose blades in axes
- contact lens overwear
- darts – often the ‘flight end’, when being removed from the board
- hot water
- hot oil
- acid, e.g., car battery
- alkalis, e.g., cleaning fluids
- toxic effects of drops and eye solutions
- traditional eye medicine
- glue and other adhesives
- antipersonnel landmines
- Exposure to ultra-violet light, e.g., unprotected eyes in snow sports, use of sunray lamps, sun-gazing
- dog bites
- hairs from spiders, caterpillars, etc.
- racquets and bats
- water balloons
- elastic bands
- thrown missiles, e.g., dirt, stones, rulers
- snooker cues
- nail guns
- air guns – pellets and bullets
- physical assault – fists, knees and elbows
How can eye injuries be prevented?
The following are those groups of people who share the responsibility for eye health promotion particularly in the context of prevention of accidents:
- Parents and teachers
- Eye health workers
Everyone in the community may play a part by showing concern for the well-being of others. Children are often victims of trauma, not only because of their innocence, but also because of the lack of supervision by their elders. However, they too may play their part in making each other aware of unsafe activities and avoid confrontational games. Adults have a larger role to play in health promotion and accident prevention. Teachers have opportunity to schedule health education activities in school. Parents and teachers should also be aware of any situation which presents opportunity for physical danger. In the home, great care should be taken, e.g., while cooking with hot oil, chopping wood, etc. When eye protection is available it should be worn, with even ordinary spectacles providing some protection, especially after eye surgery It should be stressed that even though ordinary spectacles offer some protection contact lenses do not Indeed, hard lenses may add to injury caused by a blow to the eye which may result in the lens shattering Unfortunately, the attitude, ‘oh, it won t happen to me’, can result in eye injury
Emphasis amongst health personnel has traditionally been on cause and effects of disease and treatment, rather viewing trauma as an unavoidable consequence of events10But this attitude is gradually changing with ophthalmologists and other eye care professionals co-operating with employers, sporting organisations and commercial manufacturers, encouraging the wearing of protective devices and implementing legislation to provide eye protection The human and socio-economic costs demand our attention.
The use of traditional eye medicines has also resulted in varying degrees of damage to the eyes Not all traditional practice is harmful, and traditional healers are now being integrated into primary eye care in some areas, but each of us has responsibility to help communities recognise and avoid proven harmful agents
Many eye patients have poor vision and this may cause a problem in identifying the correct eye drops for instillation. Attempts at the colour-coding of bottles are appreciated but if this is limited to bottle caps it can result in tops being replaced on the incorrect bottle Further, the same packaging has been used to market eye drops and contact lens wetting solution, as have chemical reagents and video-cassette recorder head cleaner solution, with reported serious consequences11.
Strategies to reduce the incidence of eye trauma should be directed towards prevention by means of the following:
- raising public awareness – simple, clearly worded leaflets and posters in health clinics, displays and demonstrations, street theatre, role-play
- implementing eye safety programmes – using the media, especially radio in rural areas
- introducing legislation – in the UK the seat belt law and other driving penalties have also proved to be life-saving
- occupational health and safety advice and legislation in the workplace
- school and adult education health promotion activities
- disciplining those guilty of criminal negligence
Specifically, attention should be given to safety wear, safer working practices, labelling of dangerous environments, hazard warnings and safety advice on chemical product packaging (in the UK, bleach products carry a warning in Braille), shielding of dangerous equipment, and guidelines on the manufacture and marketing of toys. Even where protective eye wear is easily available there is considerable reluctance to wearing it, for reasons that will be discussed later.
Those involved in contact sports, e.g., boxing, should encourage participants to wear face guards. This is already happening in professional cricket.
Some practical points:
- cover sticks and stakes used in fields and gardens with bottles or bottle tops
- be aware of bushes and shrubs that have thorns
- if possible, wear eye protection when chopping wood and have a secure axe handle and blade
- never look down a tube of glue or into a bottle when removing the stopper
- avoid purchasing hazardous toys
- keep harmful objects and liquids away from children
- remember that some animals and birds have sharp claws and beaks and can become hostile
- teach children about the possible dangers of pens and pencils, scissors, rulers
- avoid hazardous games and sports – wear eye protection if available
- employers should shield dangerous machinery
- supervise young children whenever possible and be aware they can poke you in the eye
- point spray nozzles away from you before pressing the handle
- read all labels and instructions before using all cleaning fluids, detergents, ammonia and any strong chemicals
- always wash your hands after using any chemical
- use a mesh guard or lid on cooking pans to reduce spattering
- wear special goggles when using a sun-lamp
- be especially careful when handling any type of hook
What influences people’s decisions to wear eye protection?
Even where people are well informed about the dangers of eye injuries, and where appropriate protection is available, vulnerable people may still choose not to wear a protective device.
- excessive cost
- lack of cleanliness
- condition – scratched, poor fit
- visibility – misting and poor peripheral vision
- not used by colleagues – the ‘macho-image phenomenon’
- having to wear prescription spectacles underneath
- wearing something someone else might have worn previously – contamination fear
- low perception of risk
Where protection is worn the following factors appear to have had a positive influence:
- previous eye injury/to self or significant other
- formal education – safety films, lectures, courses
- informal education -posters, leaflets, group talks, influence of the media
- used by others – following the example of a respected friend or colleague
- penalties and incentives – fines and rewards
- protectors stored nearby at the workplace
- high perception of risk
- concern shown by significant other, e.g., parent or spouse
Prevention must be at the core of eye injury management, whatever the cause. Much remains to be done and, while the emphasis in this article has been on the individual’s responsibility within a community, eye health care workers, in particular, must recognise the enormous need and advantage of educating those at risk of eye injury.
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11 Steinemann TL et al. Misuse of Non-ophthalmic and Ophthalmic Drops Due to Packaging Similarity. Arch Ophthalmol 1995; 113: 1578-9.