Scratched Cornea? What to Do.

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The Most Common Eye Injuries I See and What to Do About Them

by James Hubbard, MD, MPH

Cornea Rust Ring

Cornea rust ring. If a speck of metal is left in the eye, a rust ring forms around it. Usually this will go away on its own several days after the metal speck has been removed.

You’re working around your home doing some cleanup, and something hits your eye.

Or you’re hammering a nail or two and start having eye pain out of the blue—a scratching feeling. Something must have gotten in your eye, you figure.

What do you do?

Hopefully in either scenario you’ll get to a doctor ASAP, but what can you do until you can? Or what if that’s impossible?

Eye injuries run the gamut from just being a nuisance to causing devastating vision loss. In this post I’ll share the most common injuries I see. In the next post, I’ll write about others that are not quite so common but potentially even more dangerous

What to Do If You Think Something’s in Your Eye

You’re working outside, and the wind’s blowing. Something—dust?—gets in your eye.

What not to do: Remember what your mother said: Don’t rub it. Your tears will probably wash the foreign body out. If you rub your eye, you run the risk that the speck of dirt or whatever it is will scratch the cornea (the ultrasensitive, clear covering over the colored part of your eye). And the tiniest scratch there will make you feel like you’ve got a boulder in your eye every time you blink. It’ll also probably take a few days to heal.

What to do instead: Flush out your eye with clean water for about five minutes. I like to catch the water with a white cloth since sometimes I’ll catch the debris also. Then I’ll have proof it’s gone. If you’ve had no luck in five minutes, try another five. Continue this for at least a total of 15 minutes or until the debris comes out.

Plan B: If the flushing doesn’t work, get a mirror or partner because your eye needs to be examined. First, you can try literally flipping your upper lid to see if something’s hiding there. Click here to find out how to do this. If nothing’s under the lid, look the eyeball over closely. Shining a flashlight sideways across your cornea may help.

If you see something, you can moisten a cotton swab and dab at the speck to try to remove it, but you do run the risk of making the pain worse by scratching the cornea. Also, sometimes the foreign body is stuck in place, and it takes a little picking to get it out—something best left to an expert. So it’s better to leave the speck alone if you expect to get expert help within a day or two. You may want to use an eye patch so you won’t be blinking, if that makes you more comfortable.

The only other think you could try is a magnet if you think the speck in your eye is metal. Get the magnet as close to the object as you can without touching it, or barely touch it. Just make sure the magnet is very clean.

If you can’t see anything, or you get something out and still have discomfort, the cornea has likely been scratched.

How to Treat a Scratched Cornea (“Corneal Abrasion”)

Getting something in the eye can scratch (abrade) the cornea. Or you might do like I did once and accidently rub a piece of cardboard against your eye.

Needless to say, a corneal abrasion hurts. No matter the size, from the tiniest scratch to an injury that spans the entire cornea (I scratched about half of mine), your eye is going to water, and blinking usually makes it worse.

Fortunately, unless the injury goes all the way through the cornea (usually not the case) your eye will usually heal as good as new within a few days. And that’s no matter what you do. (If it doesn’t heal, something may be still in your eye, it’s a viral ulcer, or the abrasion has gotten infected. More on those possibilities in future posts.)

But there are a few steps you may want to take prevent infection, ease discomfort or possibly promote healing. And this is where we come to some controversy: What’s the best way to treat a scratched cornea?

Where experts agree: I think everyone would suggest using antibiotic eye drops if available. And until the cornea heals, both the injured and uninjured eyes will be sensitive to light. Sunglasses or a shade cover is a must if you go outside.

Where experts are unsure: For years, we’ve patched the eye shut. This prevents discomfort from blinking, and the assumption has been it also gives the cornea a better chance to heal. But some new studies have shown that healing occurs quicker when you don’t patch the eye. Also some people think patching without using antibiotic drops sets the eye up for a bacterial infection.

My experience: I’ve treated corneal abrasions with the patch and without, depending on patient preference. But I’ve also seen instances where the abrasion just didn’t seem to heal until it was patched for 24–48 hours. If you do patch, remember it takes two working eyes to judge distances. Be very careful if you’re driving or doing something else that requires you to know how far you are from something.

How to Prevent a Scratched Cornea

Most eye injuries can be prevented by using safety goggles. Wearing regular glasses can help, but added side guards help more.

What about you? Have you ever had an eye injury? What happened? What did you do?

 

Photo: Flickr/copyright Margreet Hogweg,shared under CC BY-NC 2.0.

 

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  • Shai

    I had sprayed the dog with flea spray, with Labs you have to rub it in due to their coats resisting liquid. Washed my hands, thought it was enough. Rubbed my eye. Didn’t really notice anything until the next day while boiling brine for making pickles. Almost fell down from the pain when some of the vinegar steam got in my face. A trip to the opthamologist later, I had “burned” my cornea with the dog spray, and aggravated it with the pickle brine steam. Doc produced some numbing drops and instant relief. I’ve also had calicfications form inside my eyelid which felt like sandpaper rubbing my eye every time I blinked. Same doc scraped it off, same eyedrops, and no problems since. I keep multiple eyedrops around, from tear replacement, saline flushing, and allergy drops. That same lab I was spraying is blind in one eye due to injury and subsequent fungal infection scarring the inside of her cornea. I don’t fool around when it comes to eyes.

    • http://thesurvivaldoctor.com/ James Hubbard, MD, MPH

      Thanks, Shai

  • Jeremy Armour

    Getting something in your eye is an absolutely miserable experience! I’ve had that happen more than once, and even had a significant amount of latex paint (interior wall paint) splash into my eyes when the reservoir of a Wagner Power Painter decided to fall off during use. That really sucks to by the way. It took over 30 minutes to finally rinse all that paint out of my eyes.

    However, the one enduring problem that I have with my vision isn’t an injury. It’s a so-called ‘Lazy Eye’. As I understand it most people who have a lazy eye have very poor vision in the offending eye. I don’t. My vision in my ‘lazy’ left eye is very nearly as strong as the vision in my right eye. In fact, depending upon the position of my head in regard to what I am looking at, my left eye can sometimes take over as the eye in use at which time my right eye goes wandering off on its own. The results of this are two fold; I have no depth perception, and I have a permanent double image. You do get used to this. Eventually your brain filters out the extra image so that you barely notice it, and you learn to judge distance acceptably with only one eye…just don’t try to play catch. Interestingly, I can keep both of my eyes aligned and looking in the same direction if I concentrate on doing so. (It’s at this time that I can really appreciate the difference between having depth perception and not. The world looks completely different through both eyes!) The problem is that I can’t seem to get my eyes to focus when I do this. So I can have either depth perception or a clear image, not both.

    Got any recommendations?

    • http://thesurvivaldoctor.com/ James Hubbard, MD, MPH

      Jeremy, lazy eye is usually best treated in youth. I really don’t have any recommendations other than see an eye doctor who specializes in it. Sorry.

      • Jeremy Armour

        It didn’t actually develop until the last several years. Thanks anyway though!

  • charlie

    If a piece of metal gets on the cornea it leaves a rust ring even after the metal has been removed. This requires proparacain and and alger brush to remove the rust so the cornea can heal properly without the rust in the tissue.

    • http://thesurvivaldoctor.com/ James Hubbard, MD, MPH

      Charlie, very true. However, if you can’t get to a doctor, often the small rust rings slough off.

  • Bob Smith

    If you need to cover the eye, it is better to cover both. If you can get someone to take you to get medical attention. If one eye is open both eyes will be moving and that could cause the debris to move around more.

    • http://thesurvivaldoctor.com/ James Hubbard, MD, MPH

      Thanks, Bob.

  • Janet

    I raised three daughters and a son. My youngest girl was a walking disaster! She managed to scratch her cornea twice, a few years apart, and both times from playing with a common party balloon. she was treated with antibiotic drops and a patch, and healed in a couple days. It was very painful for her and the patch gave her more comfort. It was a relief when she needed glasses, since I threatened to make her start wearing goggles. And after the second time balloons were banished!

    • http://thesurvivaldoctor.com/ James Hubbard, MD, MPH

      Janet. Thanks for the comment. Glad she made it through.

  • Melanie Blinstrub

    I thought my son would make it to his 21st birthday without ever seeking medical attention … and darn if it wasn’t a stupid wood chip that was ‘lodged’ into that outer layer that forced us to the ER on a weekend after days of pain. Weirdest little pen like odd vibrating scaping tool was used .. but trying to keep an eye open when they SCRAPE .. oh what nasty stuff that is. We had tried everything to no avail .. but praise God they got it out .. .

    • http://thesurvivaldoctor.com/ James Hubbard, MD, MPH

      Melanie, I’m glad it’s ok. Remind him to wear goggles when he’s working with wood. :)

  • drifter

    If it is metal you can use a magnet to remove it.

    • http://thesurvivaldoctor.com/ James Hubbard, MD, MPH

      Thanks, drifter.

  • longhardt

    Good stuff. I have used hot and cold packs; cold last and longest (2min then 6min) to help healing of an eye infection.
    thx for this site!

    • http://thesurvivaldoctor.com/ James Hubbard, MD, MPH

      You’re welcome. And thanks for the comment.