Work-related eye injuries are common. In the United States, more than 65,000 eye injuries are reported each year. These injuries account for substantial amount of lost productivity.
Work-related eye injuries can result from a direct injury (force) or exposure to a harmful substance (such as a chemical).
To diagnose eye injuries, doctors examine the eye, observe eye movements, and examine the eye with a slit-lamp and ophthalmoscope and may refer the person to an ophthalmologist.
The risk of work-related eye injuries can be reduced by teaching workers about potential hazards to the eyes in the workplace and requiring them to wear protective face and eye equipment.
First-aid measures are started immediately at the workplace, particularly if the eye was injured by a chemical.
Treatment depends on the cause of the injury.
(See also Eye Injuries.)
Most work-related eye injuries are reported in the construction, manufacturing, and service industries.
Work-related eye injuries may result from
A direct injury (force), such as direct blunt or penetrating blow to the eyeball, lid, or bones around the eye
Exposure to a harmful substance, such as acid or alkali, heat (thermal injuries), radiation, ultraviolet light, and/or laser light
Blunt eye injury may occur when tools slip or malfunction and strike the eyeball. Such injuries may result in bleeding into the front chamber of the eye (hyphema). Severe blunt force may result in bleeding behind the eyeball (retrobulbar hemorrhage) and, rarely, a sudden increase in pressure within the eye (called orbital compartment syndrome). Orbital compartment syndrome is a medical emergency that can cause vision to be lost. It requires immediate treatment. People with this syndrome may have double vision. Their eyes may bulge, and they may not be able to move their eyes from side to side normally.
Eye injuries may also be caused by foreign objects entering the eye.
Work-related eye injuries also include scratches on the cornea (corneal abrasions) or sclera (the tough white fiber layer covering the eye), tears (lacerations) in the eyelids, tear duct injury, and laceration of the eyeball.
Burns due to alkalis or hydrofluoric acid tend to be more serious than other acid burns because they penetrate soft tissues (muscles, tendons, ligaments, nerves, and blood vessels) more deeply. Alkalis are a component of lime products, concrete, plaster and mortar, oven and drain cleaners, dishwasher detergent, and fertilizers. Although industrial-strength products are usually more highly concentrated than household-strength products, both industrial- and household-strength products can be dangerous.
Severe chemical burns of the cornea, especially alkali burns, can cause scarring, perforation of the eye, infection, and blindness. Chemical burns to the eye are very painful. Because the pain is so great, a person tends to keep the eyelids closed. Closed eyelids keep the substance against the eye for a long time, possibly making the damage worse.
Diagnosis of Work-Related Eye Injuries
A doctor's evaluation
Eye examination, including a slit-lamp examination
For suspected fractures or radiopaque foreign objects, x-rays
Doctors diagnose work-related eye injury as they would any other eye problem. They examine the eye, observe eye movements, and examine the eye with a slit-lamp (when available) and/or ophthalmoscope. If an injury is serious, particularly if vision is impaired, doctors refer the person to an ophthalmologist (a specialist in eye disorders). Serious injuries include
Clouding of or damage to the cornea
Tears (lacerations) in the eyelids
Orbital compartment syndrome
Doctors ask people what exactly they were doing when the injury occurred. This information is essential for making a correct diagnosis. If tasks involve grinding and cutting metal using a high-speed wheel, drilling apparatus, or chisel produce, extremely small fragments of metal (or other material) may be projected into the air at high speed. If workers were not wearing appropriate eye protection, these fragments may penetrate the eyeball. The resulting wound may be hard to see during the examination. Consequently, all workplace eye injuries are promptly evaluated using a slit-lamp. X-rays of the bones around the eye may help identify metallic foreign objects in the eyeball, bone, and/or sinuses, and fractures.
If the injury involved a chemical, doctors ask what chemical was being used, what its concentration was, and how long the eye was exposed to the chemical. This information is needed to determine the appropriate treatment.
Doctors also usually measure pressure within the eye (intraocular pressure). High pressure may indicate orbital compartment syndrome.
Doctors check the eyelids for tears. If the lids are torn, the person is referred to a specialist surgeon for repair.
Prevention of Work-Related Eye Injuries
Measures to prevent work-related eye injuries include teaching workers about potential hazards to the eyes and requiring them to wear protective face and eye equipment. This equipment can includes side shields, safety glasses, goggles, and/or face shields.
Because of COVID-19, workers may be required to wear masks in addition to protective eye equipment. As a result, safety goggles and other glasses tend to fog. Tips to prevent or minimize fogging include
Fitting the mask to the face—for example, by tightening the sides of the mask or by pinching the top to fit the nose snugly
Trimming facial hair to obtain the best possible fit for the mask
Wiping the lenses of the glasses before putting them on
Pulling the mask over the nose and placing the glasses over the mask
Treatment of Work-Related Eye Injuries
First aid at the worksite
Specific treatment depending on the type of injury
Basic first aid should be given immediately at the worksite. It includes
Protecting the worker from further injury
Placing eyedrops that contain an anesthetic into the eye
For chemical exposures, liberally flushing (irrigating) the eye with tap water
For eye injury due to a chemical, doctors irrigate the eye without delaying to remove contact lenses or for anything else. Irrigation usually flushes out contact lenses.
After first aid is given at the worksite, people with eye injuries are promptly taken to a hospital emergency department. For eye injury due to a chemical, irrigation is usually continued during transport to the hospital, particularly if the chemical was an alkali or hydrofluoric acid.
Treatment of specific injuries depends on the type of injury. For example, if orbital compartment syndrome (which causes pressure within the eye to increase) is diagnosed, a surgeon clips a tendon in the outer corner of the eye where the upper and lower eyelids meet (called a lateral canthotomy). This procedure helps reduce the pressure within the eye.
Serious injuries (such as a damaged cornea, tears in the eyelid, and orbital compartment syndrome) require evaluation and follow-up with an ophthalmologist.
More Information
The following English-language resource may be useful. Please note that THE MANUAL is not responsible for the content of this resource.
Work-Related Eye Injuries and Illnesses: Discusses the diagnosis of eye injuries (including findings that suggest the cause), the eye examination, treatment, and prevention; also includes guidelines for the use of contact lenses in the workplace.
