Work-Related Eye Injuries

The evaluation of work-related eye injury is similar to evaluation of any other eye injury Overview of Eye Trauma Common causes of eye injury include domestic or industrial accidents (eg, during hammering or exposure to chemicals or cleaners), assault, sporting injuries (including air- or paint pellet-gun... read more . Evaluation can be difficult when massive lid edema or laceration is present.

Determining which specific job task and exactly what the patient was doing when injured is essential to making a correct diagnosis. Tasks involving grinding and cutting of metal using a high-speed wheel, drilling apparatus, or chisel produce extremely small metal (or other material) fragments that may be projected into the air at high speed. If workers are not wearing appropriate eye protection, these fragments may penetrate the globe, and the entrance wound may not be easily seen during gross inspection. Consequently, all injuries involving high-speed metal fragments (and all workplace eye injuries) must be promptly evaluated using fluorescein staining and slit-lamp examination done by a physician skilled in this examination.

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 Orbital compartment syndrome Consequences of blunt trauma to the eye range from eyelid to orbital injury. (See also Overview of Eye Trauma.) Eyelid contusions (which result in black eyes) are more cosmetically than clinically... read more include vision loss, diplopia, proptosis. ophthalmoplegia, and elevated intraocular pressure.

Lacerations Eye Contusions and Lacerations Consequences of blunt trauma to the eye range from eyelid to orbital injury. (See also Overview of Eye Trauma.) Eyelid contusions (which result in black eyes) are more cosmetically than clinically... read more 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.

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.

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 How To Do Lateral Canthotomy Lateral canthotomy, the emergency treatment for orbital compartment syndrome, is the surgical exposure of the lateral canthal tendon. Cantholysis is canthotomy plus incision of the inferior... read more .

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 Prevention references 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... read more , 2 Prevention references 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... read more ). 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

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