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.