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Work-Related Eye Injuries

By

Michael I. Greenberg

, MD, Drexel University College of Medicine;


David Vearrier

, MD, MPH, University of Mississippi Medical Center

Last full review/revision May 2022| Content last modified May 2022
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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

Diagnosis of Work-Related Eye Injuries

  • Detailed description of the accident

  • Examination, including fluorescein staining and slit-lamp examination

  • For suspected fractures or radiopaque foreign bodies, x-rays of the orbit

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.

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

  • For ocular burns or chemical exposures, immediately begin irrigation using tap water.

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.

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 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

  • 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

Key Points

  • Work-related eye injuries can result from physical forces or chemical exposures.

  • Initiate first-aid measures immediately, particular irrigation for chemical exposures.

  • Evaluate injuries using fluorescein staining and slit lamp examination as indicated.

  • 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.

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