Work-related eye injuries are common (more than 65,000 reported in the US annually) and account for a substantial amount of lost productivity. Most work-related eye injuries are reported in the construction, manufacturing, and service trades.
Work-related eye injuries are broadly categorized as
Traumatic injuries, such as direct blunt or penetrating trauma to the globe or surrounding structures (eg, lids, orbital bones)
Exposure injuries, such as eye injuries caused by exposure to acid or alkali, heat (thermal injuries), ultraviolet light, and/or laser light
Blunt eye injury may occur when tools slip or malfunction and strike the globe. Direct blunt trauma to the globe may result in the formation of a hyphema (anterior chamber hemorrhage). Severe blunt trauma may result in the development of retrobulbar hemorrhage and orbital compartment syndrome—a medical emergency that threatens vision and requires immediate treatment.
Work-related eye injuries also include corneal abrasions and foreign bodies, scleral abrasions, lacerations to the lids and lid margins, disruption of the tear duct apparatus, and globe laceration. Penetrating injuries may result in an intraocular foreign body.
Alkali burns and hydrofluoric acid burns tend to be more serious than other acid burns because they penetrate soft tissues more deeply.
Diagnosis of Work-Related Eye Injuries
Detailed description of the accident
For suspected fractures or radiopaque foreign bodies, x-rays of the orbit
The evaluation of work-related eye injury is similar to evaluation of any other eye injury. Evaluation can be difficult when massive lid edema or laceration is present.
Plain x-rays of the orbit may help identify metallic foreign bodies in the globe, as well as bone and/or sinus injury. MRI should be avoided if an intraocular metal fragment is suspected. CT may be helpful pre-operatively at the option of the eye surgeon. If globe laceration with or without foreign bodies is suspected, prompt ophthalmology consultation is essential.
Findings that suggest orbital compartment syndrome include vision loss, diplopia, proptosis. ophthalmoplegia, and elevated intraocular pressure.
Lacerations of the lids and lid margins should be identified and referred to an appropriate specialist surgeon for repair.
For chemical eye injuries, physicians must identify the chemical and its physicochemical properties, which are listed on the relevant Safety Data Sheet, available from the worksite. The concentration of the chemical and duration of exposure must also be identified.
Although superficial uncomplicated corneal abrasions may be followed up by family practitioners or in the emergency department, all work-related eye injuries should be considered for ophthalmology follow up. Injuries that require immediate ophthalmology consultation include those with corneal opacification or sloughing, conjunctival blanching, lid lacerations, and orbital compartment syndrome.
Treatment of Work-Related Eye Injuries
First aid at the workplace
Specific treatment depending on the type of injury
Basic ocular first aid should be given immediately at the workplace. First aid includes protecting the worker from further injury, instilling a topical anesthetic, and, when indicated (eg, for chemical injuries or burns, injuries with possible occult foreign bodies), liberally irrigating the eye with tap water. Special irrigating fluids are not necessary, and irrigation should not be delayed to obtain any irrigation fluid. For chemical exposures, irrigation should not be delayed to remove contact lenses. Irrigation usually causes contact lenses to be flushed out. Applying a Morgan lens to the eye facilitates prolonged irrigation.
Pearls & Pitfalls
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After ocular first aid is given at the worksite, patients with work-related eye injuries should be promptly referred to a hospital emergency department because worksite clinics may lack practitioners with expertise, equipment needed to accurately evaluate these injuries, and resources to refer workers to knowledgeable ophthalmologists. For chemical exposures, irrigation should usually continue during patient transport, particularly for alkali or hydrofluoric acid burns.
Specific injuries are treated similarly to non–work-related eye injuries. Orbital compartment syndrome may require lateral canthotomy.
Prevention of Work-Related Eye Injuries
Prevention of work-related eye injuries requires worker education as well as the use of face and eye protection that meets American National Standards Institute (ANSI) standards (1, 2). Eye protection should always include side shields because even foreign objects originating in front of the worker (eg, from a tool or machine) can bounce off nearby objects and strike the eye from the side. Special safety glasses, goggles, and shields are required for workers with possible exposure to hazardous radiation, including welding, lasers or fiberoptics.
COVID-19 has necessitated the wearing of masks in addition to eye protection. Fogging of safety goggles and other glasses is a problem. Tips to prevent or minimize fogging include
Fitting the mask to the face (eg, tightening the sides, pinching the top to fit the nose snugly)
Wiping the lenses before wearing the glasses
Prevention references
1. Occupational Health and Safety Administration: Eye and face protection. Accessed 4/12/21.
2. American Academy of Ophthalmology: Prevent workplace eye injuries during COVID-19. 2021. Accessed 4/12/21.
2. Health and safety at work: Eye protection: A guide to provision and use. Medical Research Council Clinical Sciences Centre, 2010. Accessed 4/12/21.
Key Points
Work-related eye injuries can result from physical forces or chemical exposures.
Initiate first-aid measures immediately, particular irrigation for chemical exposures.
Refer workers with any work-related eye injury to an ophthalmologist for follow-up.
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: Information about diagnosing eye injuries (including findings that suggest the cause), the eye examination, advance preparation of an eye tray for treatment, treatment protocols, prevention, and guidelines for the use of contacts in the workplace.
