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Work-Related Eye Injuries and Illnesses
Abstract & Commentary
By René J. Beckham, MD, Internal Medicine Consultant, National Imaging Associates, Phoenix, AZ, is Associate Editor for Urgent Care Alert.
Dr. Beckham reports no financial relationships to this field of study.
Synopsis: Overview of prevention and treatment of work-related eye injuries and illnesses.
Source: Peate, WF. Work-related eye injuries and illnesses. Am Fam Physician. 2007;75:1017-1022.
There are more than 65,000 work-related eye injuries and illnesses each year in the United States.1 This is troublesome not only because of the morbidity and disability associated with it for the employees, but the effect of the high absenteeism on the employer groups as well. The reality of it is that over 90% of these injuries could have been prevented with proper eye protection.2
Urgent care clinics must be prepared for these injuries when they present to minimize the morbidity and disability. The most important part of preparation is to have a well stocked eye tray and to complete and document an initial visual acuity exam for future comparison.
Eye Tray :
Diagnosis and Management
This usually occurs after a trauma to the eye where there has been a foreign body rubbing or scratching the eye. Common symptoms include pain, tearing, blinking, blurry vision, or pain with movement. The exam should be preceded by instilling topical anesthetic to decrease discomfort, then evaluating for a foreign body with eyelid eversion using a cotton swab. The abrasion can then be diagnosed using fluorescein dye and a blue filtered light. Studies have shown that eye patching does not increase healing or decrease discomfort, and often increases pain for patients.3-5 The treatment, therefore, consists of topical antibiotic ointment or drops and oral pain medication. The patient will need referral to an ophthalmologist only if healing does not occur over the following 3 days or there remains evidence of infection.
After instilling a topical anesthetic, evaluation should be performed with a saline-soaked cotton swab and should include eversion of the eyelid. An eye wash can remove minor irritants such as soot. A foreign body which is deeper in the cornea, or a rust ring, can be removed with an 18-gauge needle and a slit lamp. If these tools are not available, or this can not be accomplished easily, the patient should be referred to an ophthalmologist.
This can cause more serious injury such as bleeding into the retina, anterior chamber, or vitreous. It can also cause eyelid lacerations involving the eyelid margins, or there may be penetrating injuries associated the trauma. Traumatic mydriasis is caused by a concussive blow to the glob or orbit and should not be confused with a "blown" pupil caused by a third cranial nerve palsy. Any of these more serious injuries should be referred to a specialist.
Ocular chemical burns make up a significant percentage of work-related eye injuries6 and require rapid treatment. The initial treatment is irrigation with one liter of saline over one to 2 hours and prompt referral to an ophthalmologist.7 Litmus or pH paper can be used and when it is near neutral,6-8 the irrigation can be discontinued.
Allergic conjunctivitis is most commonly caused by a stimulus at work. Patients may have other allergy type symptoms with it, and their symptoms improve when they are outside of work. Patients can go through more specific allergy testing if this is suspected and be treated with topical mast-cell stabilizers or antihistamines.
Work place instructions must be given when any worker is diagnosed with infectious conjunctivitis. These include frequent hand washing, no shared towels, and disinfecting all work surfaces. Those with bacterial conjunctivitis should be treated with topical antibiotics and off work 5-7 days, or until the discharge clears, while those with viral conjunctivitis should not return to work until 7-10 days after the onset of symptoms.8
The Occupational Safety and Health Administration (OSHA) mandates employers provide workers with adequate eye protection.9 This includes well-fitting, indirectly-vented goggles or a full-face respirator to prevent exposure to chemical and caustic hazard. When a chemical exposure occurs in those with contact lenses, irrigation should be started immediately and the contact lens removed as soon as possible.
Despite the continued efforts in the workplace to implement safety precautions, there is a significant rate of occupational eye injuries and illnesses. The urgent care clinic is a logical location for many of these ocular urgencies to present, and each clinic needs to be prepared to treat them efficiently and quickly to prevent future morbidity and disability. It is also clear that the physicians need to know their abilities and limitations in treating these injuries, and refer to an ophthalmologist when necessary.