Take "Every Possible Measure" To Protect Your Eyes

Each day about 2000 workers in the US have a job-related eye injury that requires medical treatment. About one-third of the injuries are treated in hospital emergency departments and more than 100 result in one or more days of lost work.

The majority of these injuries result from small particles or objects striking or scratching the eye. These objects can include metal slivers, wood chips, dust, and cement chips, and are often ejected by tools, blown by the wind, or fall from above a worker.

Workers can also sustain blunt force trauma when large objects strike the eye, face, or head, or when the worker runs into an object. Blunt force trauma can cause damage to the globe of the eye (the eyeball) or eye socket. Some workers are at risk for chemical burns to the eye from splashes of industrial chemicals or cleaning products, or thermal burns to the eye from furnace operations. Among welders, their assistants, and nearby workers, UV radiation burns (welder's flash) can damage workers' eyes and surrounding tissue.

Anytime, Any Workplace
Judy E. Kim, MD, Medical College of Wisconsin Associate Professor of Ophthalmology, practices at the Eye Institute of Froedtert & The Medical College. She says eye injuries can happen at anytime in the workplace. "It could be a blunt injury, where something hits the eye, or a penetrating injury, where something pokes into the eye. Falls sometimes cause eye injury as well; they can cause orbital fractures of the bone around the eye, a retinal detachment, or a hemorrhage inside the eye. Any head trauma carries the risk of an eye injury."

In addition to these more common eye injuries, health care workers, janitorial workers, laboratory staff, and others can acquire infectious diseases through their eyes. Infectious diseases can be transmitted through the mucous membranes of the eye by direct exposure to blood or respiratory droplets, or by touching the eyes with contaminated fingers or other objects.

Given these risk factors, says Dr. Kim, "It's best to prevent these injuries and infections from happening. I always recommend taking every possible measure to protect your eyes."

Protection is Essential
Protective eyewear is the best way to avoid a direct eye injury. Dr. Kim says there are different types of safety glasses for different workplaces. "At my workplace, for instance, we use lasers, and every bystander is required to wear a certain type of glasses which filter out specific wavelengths of light. These are very different from the breakage-resistant polycarbonate glasses people might wear in an industrial setting, where they need to protect their eyes from flying objects."

In general, safety glasses should be used in workplaces where there are small amounts of dust, chips, or flying particles. Use goggles, which completely enclose the eye, for better protection from larger amounts of dust, bigger chips, and chemicals. Use face shields for protection from large or high-speed chips, and from chemical or blood-borne hazards. Face shields may be tinted or coated with metal for heat and splatter protection, and should always be worn with safety glasses or goggles underneath.

In addition, helmets and hardhats should be worn to protect the eyes from flying debris, and to help prevent the blunt head trauma that can lead to eye injuries.

It's also important that workers keep the safety equipment on at all times. "We've seen a lot of eye injuries in people who do industrial work," says Dr. Kim. "Workers might take their safety glasses off, just for a minute, and that's when bits of metal or other material get into the eye."

Not Just Heavy Industry
Industrial settings are not the only workplaces that call for eye protection. People who work outside, such as construction workers and landscapers, are also at risk for eye damage. "Whether it's a professional landscaper or a college student working for the summer, if they don't wear safety glasses, rocks or other flying debris can cause serious eye injury," Dr. Kim says.

She advises these workers to wear sunglasses in addition to safety glasses, or use tinted safety glasses. "The sun accelerates the progression of cataracts and age-related eye diseases like macular degeneration in some people," she says, "so sunglasses are a must." Because the sun can cause skin cancer around the eye, Dr. Kim also recommends wearing sunscreen and a hat with a brim when working outside.

Dr. Kim gives some further advice for avoiding workplace eye injuries. "Keep the work area safe, so people don't trip, slip, or fall." This includes keeping carpets flat and not frayed, using sturdy railings on stairs and upper levels, and making sure the workplace has good lighting. "What you would want in your own home should carry over to the workplace," she says. "If boxes are stacked up around the workplace, workers can bump into them or get hit by them. They can slip on standing water or other liquids, and inhale excessive dust or chemical fumes. It's really just common sense."

Dr. Kim notes that car crashes also contribute to the number of eye injuries, and reminds people to drive carefully on the way to and from the workplace.

Tools of the Trade
The instruments Dr. Kim uses to inspect an eye injury are the same ones used in eye exams. "If the eye is not filled with too much blood, we look inside the eye with an ophthalmoscope." An ophthalmoscope is about the size of a flashlight, with a light source and a disk of rotating lenses. It projects a beam of light directly through the pupil, to view the back of the eyeball.

In slit-lamp ophthalmoscopy, the patient and physician sit on either side of an instrument that concentrates light into a slit, which gives a more three-dimensional view of the eye. "We also have an indirect ophthalmoscope," says Dr. Kim, "which is a binocular-type instrument that focuses bright light toward the back of the eye."

Dr. Kim also performs x-rays and ultrasounds on patients' eyes if necessary. Ultrasounds are particularly helpful in cases where blood from the injury or a hemorrhage makes the ophthalmoscope difficult to use, and x-rays can "see" foreign objects or bone fractures that an ophthalmoscopy might miss.

Treatment Options Vary
If there is a laceration or a rupture of the eyeball, the location and severity of the injury determine how much of the eye and its vision can be saved. "A laceration has to be sewn up," says Dr. Kim, "but usually, if the retina hasn't been damaged too badly, the patient can have good vision again after the surgery."

In the case of a blunt trauma with no rupture or laceration, physicians might simply wait for the contusion to go away. If the blunt trauma has caused a hemorrhage, however, "we either wait for the blood to leave the eye," explains Dr. Kim, "or perform a vitrectomy surgery, which evacuates the blood from the eye." The vitreous is the gel-like substance in the eye. In a vitrectomy, Dr. Kim makes a tiny incision in the eye. A small instrument is used to remove the vitreous gel that is clouded with blood, and it is replaced with a saline solution.

Eye injuries can sometimes cause a cataract to form on the lens of the eye. "If either a blunt or penetrating trauma causes a cataract," says Dr. Kim, "we can remove the lens and put a new one in."

Safety and Prevention First
To help prevent workplace eye injuries, always use protective eyewear and headgear when working with heat, dust, particles of any size, optical radiation, and hazardous chemicals. Remove dust and debris from hats, hair, forehead, and glasses before taking off protective eyewear, and don't rub your eyes with dirty or contaminated hands or clothing.

Despite the wide variety of treatment options and the possibility of a full recovery from an eye injury, Dr. Kim emphasizes safety and prevention. "Eye injuries can be quite devastating," she says. "They can cost you your livelihood, and even cause blindness."

P. J. Early
HealthLink Contributing Writer

This article includes information from the US Centers for Disease Control and Prevention (CDC), the Occupational Safety & Health Administration (OSHA), and the National Institutes of Health.

MCW Health News presents up-to-date information on patient care and medical research by the physicians of the Medical College of Wisconsin.