How to safely treat an eye injury

Transcript

Joey Wahler (Host): It is important to know what to do if one occurs. So, we’re discussing eye injuries. Our guest is Dr. Alejandro Espaillat. He’s an ophthalmologist with Prisma Health. This is Flourish, a podcast from Prisma Health. Thanks so much for joining us. I am Joey Wahler. Hi, Dr. Espaillat. Welcome.

Dr. Alejandro Espaillat: Thank you very much, Joey. I’m very happy to be here.

Host: Great to have you. Appreciate the time. So first, what are some of the more common eye injuries you treat? And how does someone know if one constitutes seeking emergency attention?

Dr. Alejandro Espaillat: Sure. Eye injuries can range from mild to vision threatening. So, it’s important to act quickly and appropriately. Now, if you experience a chemical splash, immediately, patients should flush their eyes with clean water for at least 15 minutes and seek emergency care. Sometimes it’s just blunt trauma, like getting hit in the eye during the fight or hammering at home. Patients should apply cold compresses gently to reduce swelling and get evaluated, especially if there’s pain, blurry vision or floaters. If it’s a cut or a puncture, patients should avoid touching or rinsing the eye, cover it lightly with a shield, not pressure and get to the ER right away. They should never try to remove an object that’s stuck in the eye. They should leave it so the medical professional can examine it and treat it. Even what seems like a minor injury can lead to serious complications. When in doubt, you have to just get it checked. Prompt treatment can make the difference between recovery and permanent vision loss.

Host: You mentioned the term floater. I’ve had one myself. It was years ago, and I had it for a long time, and now it seems to have gone away unless I’m just so used to it that I don’t notice it anymore. What a floater and can they go away?

Dr. Alejandro Espaillat: Oh my God, that is such a common question and a great question. I actually have five myself.

Host: Five?

Dr. Alejandro Espaillat: Yes. Well, the eyeball has a gel inside this. It’s just like when you crack an egg, you will have the clear part of the egg and the yolk. Well, the eyeball has a clear part, just like the egg has it, and it’s called the vitreous. Now, when we are young, it’s very tight and solid. But as we grow older, it becomes more liquified and it loses collagen and starts to move around inside of the eyeball, sometimes starts to detach a little bit and causes some flashes of lights. Now, when it crosses in front of our vision, the patient can actually be aware of it. And you can see it, especially if you have a light background, like blue lights or the sky, and it looks like a speck, like a little thread. For those who have hair, they think it’s a hair in front of them, or that a fly is in front of their vision. So, it’s actually very funny. But the brain suppresses that image. They’re there and they don’t go away. They will never go away, but your brain will suppress that image and you will see them only occasionally.

Now, the reason why we ask patients to come so we can see them at the clinic is because sometimes those floaters could be other things, either blood in patients with diabetic retinopathy or inflammation in patients with infections, or even tumors like lymphomas inside of the eye or retinal detachment. So, those are things that are worrisome and must be checked. But regular floaters from vitreous detachment, it’s benign and doesn’t need to be treated. Your brain will just suppress that image and you will not be bothered by it most of the time.

Host: You mentioned a moment ago what to do if you get chemicals in your eye. How about what should someone do or not do if you get something in your eye like sand or maybe an eyelash?

Dr. Alejandro Espaillat: If it’s sand, well, you should actually flush it out with clean water. Ideally, you can do it from a bottled water or regular tap water, and visit the emergency department because sometimes the sand can actually come with other particles that may cause some issues and degenerations and infections, viral infections, bacterial infections or fungal infections.

If it’s an eyelash, again, the same way would be just to try to flush it out with water or in an eyewash station. If you’re stuck in the eye, you should not pull it. You should actually let the physician take a look at it, because what may seem like a regular eyelash, it could actually be something else. When we examine these patients, we use magnification. And that’s how it allows us to understand exactly what the particle is.

Host: How about if contact lens gets stuck in your eye?

Dr. Alejandro Espaillat: That’s very common. It is very bothersome. It usually will get stuck in the eye when patients tend to overuse them and there is very minimum lubrication, or the contact lens is very tight and small leading to lack of oxygen. In those cases, it can actually cause lots of symptoms for the patient, including tearing, foreign body sensation, or even leading to severe infections with loss of vision. So, we always recommend to the patients to remove their contact lenses every night, even though there are some that they say you can leave them on for 30 days, I do not agree with that. I tell my patients not to use their contact lenses more than eight hours a day and never to sleep with them. Because when you sleep with them, you’re actually suffocating the front part of your eye. And that is a media culture for bacteria to flourish and cause significant infections. So, if that were to happen, you’ll have to visit your eyecare provider, in order for that to be treated or have the contact lens removed.

Host: All right. Great advice indeed there. Now, how exactly do contact lenses, Doctor, typically get stuck? And what do you do if you can’t find it?

Dr. Alejandro Espaillat: The reason why you cannot find it is actually because you can’t see very well, or that the contact lens is so dry that has completely attached to the eye, causing significant irritation, lack of oxygen and pain, discomfort. You should not try to do it yourself if you are getting to that point. That usually means overutilization of the contact lenses and that needs to be treated by an eyecare provider. You need to visit your eyecare provider for that.

Host: How about if you scratch or cut your eye? I know that oftentimes people that play basketball, you take an elbow underneath the basket and before you know it, an injury like that occurs.

Dr. Alejandro Espaillat: That usually causes something called a corneal abrasion. If you have a cut or a puncture, you have to avoid touching or rinse in the eye. You have to maybe just cover it lightly with a shield, not apply any pressure, and get to the emergency department right away. Because many times, those scratches can lead to bacterial infections. Or like for example, I had a patient yesterday that had a corneal abrasion from his dog. And now, the paw of the dogs, it can carry a lot of dirt and bacteria and fungus. So, that can lead to severe infections that must be treated and looked at, and this infection can actually lead to permanent loss of vision and scarring. So, you can get an abrasion while you’re playing basketball. You can get an abrasion at the beach with the sand. You can get an abrasion playing with your pets, cats and dogs. They are very common elements of possible sources of these lesions.

So, you have to just see your eyecare provider. It’s not something that you can treat by yourself at home. These abrasions can lead to a lot of issues. When they treat it properly, they can heal it within 24 hours. But if it’s not treated properly, then even if they heal, they cannot heal adequately, and patients can develop what we call recurrent corneal erosion all of the time. And that can lead to major issues further down the road. I would recommend to use eye protection, eye shields, especially when you’re hammering on the wall or when you’re playing certain sports, like contact sports. You should wear your special eye shields.

Host: Some of us that are a little older, Doc, and follow basketball will recall Kareem Abdul-Jabbar being the first one that made playing with goggles famous because he took a shot in the eye and didn’t want to ever have any damage again, right?

Dr. Alejandro Espaillat: Absolutely. And most of the department stores, they sell protective eye goggles that cover your eye, not only in the front, but also on the side. I also had a patient recently, a 17-year-old, boy who likes to be doing a lot of outdoor activities. And he was grinding some material and he was wearing glasses, but he was not wearing the protective glasses. So, the particles went under the glasses and lodged in his eyes. And it was very uncomfortable for him. So if you’re going to practice either any contact sport or you are going to do some type of drilling, grinding, polishing or hammering, you should wear eye protection.

Host: A few other things. You touched on this, but just to dive into it a little more deeply, if you do get hit in the eye, you mentioned you should not try to treat it at home. You’re not qualified as a lay person, if you will. So, you mentioned the importance of getting checked out by a doctor, and one reason is because it can lead to long-term injuries if something goes untreated. What are some of the things that can happen in that circumstance?

Dr. Alejandro Espaillat: For example, if someone gets punched in their eye, you can develop orbital fractures, you can develop a ruptured globe, you can develop swelling, hematomas, bleeding, infections, loss of the eye, retinal attachments, et cetera. If those are the issues, not a punch, but accidents; if someone is driving a car and there is a deployment of the airbags, the airbags they have surface powder that is very irritating to the eyes. And thank God they’re alive and they were not killed because of the accident, but now they have these chemical conjunctivitis, or chemical irritations or keratitis or allergic reaction to the powder itself. And that can lead to a lot of issues as well. Not only long-term issues, but also immediate issues. So, they also need to be checked by their eyecare provider. You can also get accidental trauma through particles that get picked up from the ground.

I actually published the paper on a patient, she was sitting in the back seat of a convertible car. And the driver stopped at a gas station. And the car in front of them sped up very fast. And the back wheel picked up a rod that flew and impaled the patient in the back seat of the convertible. I published that paper and it made it to the cover of one of the American Ophthalmology journals. It was just terrible because, you know, thank God the patient was saved. So, there are many things that can happen in the trauma, like fractures, ruptures, infection, hematoma, bleeding or abrasions. So, all of the things they need to be taken very seriously, because they can have immediate ramifications as well as long-term ramifications.

Host: And speaking of which, when you talk about the importance of seeing a doctor in a timely manner, how do you know these days whether you should see an eye doctor or an urgent care facility or an ER? Where’s the line there?

Dr. Alejandro Espaillat: I would say the line is based on the urgency. It is sometimes difficult to find an appointment at a physician’s office the same day. Many offices, they have slots allocated for emergencies, or urgency within 24 hours or 48 hours if they are referred by another provider. So if it’s an emergency or an urgency, if you call your eyecare provider and they don’t have an appointment available for you, you should go to the urgent care or the ER. Financially speaking, it’s probably always better to go to an urgent care. It will be less costly for the patient than going to an emergency department, and they have physicians as well. They are well trained on the initial emergency situations that need to be treated.

Now, if it’s a motor vehicle accident or a significant trauma, you should go to an emergency department. Those are the things that you should do in case of an emergency. If it’s a routine care, if the patient is African American or Hispanic, they have six times higher risk of developing certain diseases like glaucoma and diabetic retinopathy, but mostly glaucoma. Caucasians, patients have a much higher risk of developing a disease called macular degeneration. So, we see this all the time. These are diseases which do not cause any symptoms and they must be checked regularly starting at a certain age, but that is a topic of another podcast that probably we will have a chance to go over that.

Host: Excellent. I look forward to that. And then, finally, in summary here, Doctor, what’s the main message you want to get across to those joining us about eye injuries in general? It seems like the theme here is better safe than sorry if something happens, right?

Dr. Alejandro Espaillat: I think the main message is that even what seems like a minor injury can lead to serious complications. So when in doubt, you have to get it checked. Prompt treatment can make the difference between a full recovery or permanent vision loss. That is what I like to leave the podcast with.

Host: Great advice indeed. And folks, we trust you are now more familiar with eye injuries. Dr. Espaillat, keep up all your great work and thanks so much again.

Dr. Alejandro Espaillat: Thank you for having me.

Host: And for more information, please visit prismahealth.org/flourish. If you found this podcast helpful, please do share it on your social media. I’m Joey Wahler. And thanks again for being part of Flourish, a podcast from Prisma Health.

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