What are the signs of a serious eye injury that require immediate emergency care?

Eye injuries require comprehensive and immediate medical attention, even if they initially appear minor. It is a common misconception that every eye injury can be treated at home; often, the severity of the damage is not visible to the naked eye, and delaying medical examination can lead to permanent complications such as vision loss or irreversible damage [1]. If you suspect an eye injury, the golden rule is not to attempt self-diagnosis or treatment, and to go to an ophthalmologist or the emergency department as soon as possible for an accurate assessment [1].

Warning signs requiring immediate emergency care

Any of the following signs should be considered an alarm bell requiring urgent medical intervention, as they are strong indicators of internal injury or severe damage to the eye's structure [1]:

• Vision disturbances: Any sudden change in visual acuity, such as blurred vision, loss of part of the field of vision, or abnormal light flashes.
• Persistent pain or discomfort: Pain that does not subside over time or increases in intensity after the injury occurred.
• Anatomical changes in the eye: Observing an abnormal difference in the size or shape of the pupil, one eye protruding more than usual, or the inability of the eye to move in harmony with the healthy eye.
• Bleeding inside the eye: Seeing blood concentrated in the colored part or the clear part of the eye, which may indicate internal injuries such as a "hyphema" [2].
• Eyelid lacerations or foreign bodies: Any wound on the eyelid, or a foreign object stuck that does not come out with natural blinking or eye washing, especially if the causative materials are small metal or glass pieces [1].

How to deal with different types of injuries

In emergencies, the first steps are crucial in minimizing the extent of damage before reaching the hospital:

• Chemical exposure: This is considered a critical emergency. The eye must be flushed immediately with abundant amounts of clean water or saline solution to ensure the removal of the causative substance, while attempting to identify the chemical type to assist the medical team [1].
• Direct blows: When struck by a ball or a hard object, a cold compress can be applied gently to reduce pain and swelling, provided that no direct pressure is placed on the eyeball. If the blow is accompanied by vision disturbance, this is an indication that requires immediate examination to rule out retinal detachment or orbital fractures [1].
• Punctures and penetrating wounds: In case of a suspected puncture or deep wound, the eye should be covered with a protective "shield" that protects it from external pressure (the bottom of a paper cup can be used) without touching the eye itself or applying pressure to it. Avoid using any drops or ointments, which could be harmful in this situation [1].

Important warnings: Mistakes to avoid

To protect the eye from worsening damage, it is strictly forbidden to rub the eye or apply pressure to it; movement may worsen the wound or help foreign bodies penetrate the deep layers of the eye [1]. It is also forbidden to attempt to remove any embedded or implanted objects from the eye on your own. Additionally, it is advised to avoid taking common painkillers such as aspirin or ibuprofen before medical examination, as they act as blood thinners and may increase the intensity of bleeding in the eye [1]. For more details on preventive measures, you can review our full guide on Eye injuries in work and sports: Prevention and first aid (Arabic) to ensure your safety and the safety of those around you.

Medical references

• Recognizing and Treating Eye Injuries
• Eye Injuries