By Greg Ling
It's an injury that can come from anywhere: a baseball in the eye, an elbow from another athlete, or a sucker punch to the face. Any sport in which players collide or hit each other with sticks can cause a black eye -- and much worse damage if blood collects behind it and results in vision loss.
If the injury is serious enough, blood can accumulate in the eye's anterior chamber -- the fluid-filled space between the cornea and the iris -- and appear as a dark pool in the iris. This is known as hyphema and can be quite serious, potentially causing vision problems and cornea damage. Less serious is a subconjunctival hemorrhage, a ruptured blood vessel typically caused by rubbing the eye or coughing forcefully. Although it may look worse due to leaking of blood into the white part of the eye, a subconjunctival hemorrhage will usually resolve itself without any treatment.
According to the American College of Emergency Physicians, even superficial damage to the eye's surface can lead to vision problems, so you should take great care whenever an eye injury occurs and seek medical attention when necessary.
What causes bleeding in the eye?
Many cases of bleeding in the eye are the result of trauma caused by blunt objects, falls, fights, and sports injuries. In fact, sports accidents alone cause more than 40,000 eye injuries every year, according to the American Academy of Family Physicians, which is why the group advocates wearing eye protection on the playing field or court. Disorders such as inflammation of the iris, a blood vessel abnormality, or eye cancer can also lead to bleeding in the eye.
The academy recommends that you see a doctor immediately if there is blood in your eye and any of the following symptoms or conditions is present:
- Sudden decrease in or loss of vision
- Pain on movement of the eye
- Unusual sensitivity to light
- Double vision
- Bulging of the eye
- Light flashes or floaters
- Irregularly shaped pupil
- Foreign-body sensation (or an embedded foreign body)
- Redness and inflammation of the eye
- Halos around lights
- Severe cuts on the eyelid
- Red patches on the whites of the eyes
- Loss of field of vision
- Broken contact lens or shattered eyeglasses
- Puncture to the eye
What should you do if someone is hit in the eye?
According to the American College of Emergency Physicians, you should first lay the person on his back, holding his head on your knees to keep it as still as possible. Don't touch the injured eye, and tell him to keep his eye closed and not to touch it.
If an object has penetrated the eyeball, don't apply pressure to the eye or try to remove the object. Call 911 immediately, and hold the object in place to prevent further movement and damage to the eye. Also, if the eyeglasses have shattered or the victim is wearing contact lenses, don't attempt to remove the lenses or glass from the eye.
If there is no object lodged in the eye, bandage the eye with an eye shield or place a paper cup over the injured eye to keep the victim from touching it and to protect it from airborne irritants. (If possible, tape the paper cup in place.) If the bleeding is so severe that you have to change bandages, call 911 immediately.
For a wound with lesser bleeding, take the victim to the emergency room. To minimize blood loss, make sure the victim is lying flat on her back when you transport her. If getting medical attention will take a while, keep the bandage on the eye to shield it.
First aid for minor cuts around the eyes
For a very minor skin cut near the eye, wash your hands first to avoid infection, wash the cut with mild soap and water, and apply light pressure to the cut to stop the bleeding. Never put any pressure on the eyeball. Apply a sterile bandage, if you have one; otherwise, use a clean bandage or cloth.
If you're concerned about the cut, play it safe and have a doctor check it out. (For example, a small cut on the inner eyelid can damage tear ducts or may be at risk for infection, so the wound should be looked at by a doctor.)
What should you do in the days after treatment?
Fifteen to 20 percent of people experience more bleeding in the three to five days following the injury, so following doctor's orders is a must. Your doctor may tell you to get lots of bed rest and avoid strenuous activity. If you're going to take a pain reliever, make it one without aspirin or ibuprofen, which can promote bleeding. Acetaminophen (Tylenol) is your best bet.
American College of Emergency Physicians (ACEP): Preventing Eye Emergencies. http://www3.acep.org/practres.aspx?id=26032
American Academy of Family Physicians (AAFP): Eye Injuries in Sports. http://familydoctor.org/794.xml
American Academy of Ophthalmology (AAO): Important Facts about Eye Injuries. http://www.medem.com/search/article_display.cfm?path=\\TANQUERAY\M_ContentItem&mstr=/M_ContentItem/ZZZI8OQWIOC.html&soc=AAO&srch_typ=NAV_SERCH
Eye Injuries. Nemours Foundation. http://kidshealth.org/parent/firstaid_safe/emergencies/eye_injury.html
National Institute for Occupational Safety and Health: First Aid for Eyes. http://www.cdc.gov/nasd/docs/d000801-d000900/d000814/d000814.html
American Academy of Ophthalmology (AAO), Medical Library: Treating an Eye Injury. http://www.medem.com/search/article_display.cfm?path=\\TANQUERAY\M_ContentItem&mstr=/M_ContentItem/ZZZCAQQWIOC.html&soc=AAO&srch_typ=NAV_SERCH
Hyphema (Bleeding in Eye) eMedicine Consumer Health. http://www.emedicinehealth.com/articles/13637-1.asp
Black eye, MayoClinic.com http://www.mayoclinic.com/invoke.cfm?objectid=BB681DC6-26D4-410E-86BB83DB11639C9B
American Family Physician, Prevention and Treatment of Common Eye Injuries in Sports http://www.aafp.org/afp/20030401/1481.html
Subconjunctival hemorrhage. National Institutes of Health and U.S. National Library of Medicine. http://www.nlm.nih.gov/medlineplus/ency/article/001616.htm
Hyphema. National Institutes of Health and U.S. National Library of Medicine. http://www.nlm.nih.gov/medlineplus/ency/article/001021.htm
Cuts and puncture wounds. National Institutes of Health and U.S. National Library of Medicine. http://www.nlm.nih.gov/medlineplus/ency/article/000043.htm