Eye Injuries: The First Aid Is Different for Every Cause

Chemicals or fumes in the eye: flush with water for at least 15 minutes, starting now, and keep flushing on the way. A cut to the eye: do not wash it and do not press on it. Any loss of vision is an emergency.

Most first-aid advice generalises. Eye injuries do not — and two of the instructions are opposites.

For a chemical splash, the American College of Emergency Physicians says to flush the eye with water for at least fifteen minutes. For a cut to the eye, they say do not wash it with water or any other liquid.

Same organ, opposite instruction. Which is why this page is organised by what happened rather than by what it feels like, and why “rinse it and see” is not a universal answer.

Three things that are emergencies regardless of how they feel

ACEP names these as needing emergency attention:

A visible wound.

Loss of vision, partial or total. Including a patch, a shadow, a curtain, or blurring that is new.

Any eye contact with chemicals — “including fumes.”

That last word does the most work. People understand that bleach in the eye is an emergency. Almost nobody counts fumes, and ACEP puts them in the same sentence. Cleaning products used in a small bathroom, pool chemicals, a garage, anything ammoniated — if your eyes have been exposed to fumes and hurt, that is a chemical exposure.

Chemical splash or fumes: flush, and flush for longer than feels reasonable

“immediately flush the eye with water for at least 15 minutes” — and “Hold under a faucet or shower and keep the eye open as wide as possible. Do not touch or rub the eye.”

Fifteen minutes is far longer than anybody does voluntarily. A ten-second rinse is the usual attempt, and it is not the instruction. Get under a tap or a shower, hold the lid open, and stay there.

And tilt the head so the water runs away from the other eye. ACEP’s instruction on chemical exposure elsewhere is explicit about it: “Make sure the water is flowing away from the uncontaminated eye.” Otherwise you rinse the chemical out of one eye and into the other, which is a detail almost nobody knows and costs nothing to get right.

Do not stop flushing in order to leave for the emergency room. Flush first, keep flushing on the way if somebody else can drive, and do not spend the time looking up what the chemical was — bring the container if it is to hand.

Do not rub. Rubbing grinds whatever is there into the surface it is already damaging.

A blow to the eye

“apply a cold compress without putting pressure on the eye.”

Cold, resting near it rather than on it. The globe is a pressurised structure and pressing on an injured one can do harm — which is why a bag of peas held firmly against a black eye is the wrong version of a right idea.

And the warning signs ACEP names for an injured eye, both of which need evaluation: “a bloodshot eye appearance” and “leakage of blood or clear fluid from the injured eye.”

Clear fluid is the one to know. Most people would be alarmed by blood and reassured by something clear. Do not be — clear fluid leaking from an injured eye is on the list, and it goes straight to an emergency room.

Something stuck in the eye

“do not try to remove it. Do not rub or apply any pressure.”

Leave it exactly where it is. No tweezers, no cotton bud, no corner of a tissue, no attempt to blink it out. Cover the eye loosely without pressing — a paper cup taped over it is the traditional improvisation and it works because it touches nothing.

And do not let the other eye do the work. Both eyes move together, so keeping both still, or covering both, reduces movement of the injured one.

A cut to the eye or eyelid

“do not wash with water or other liquid. Do not apply any pressure.”

This is the opposite of the chemical instruction and it is the one most likely to be got wrong, because rinsing a wound is the trained reflex for every other cut on the body.

Do not irrigate it. Do not press on it. Do not remove anything. Cover loosely and go, or call 911 if there is significant injury alongside it.

Come in

Call 911 for a penetrating injury, for significant bleeding, for an injury alongside a head injury or collapse, or for chemical exposure in somebody who cannot flush their own eye — and keep flushing while you wait.

Come to an emergency room for any visible wound, any new loss or change of vision, any chemical or fume exposure, anything embedded, a blow that has left the eye bloodshot or leaking, severe pain, light sensitivity that is new and severe, or an eye injury in a child.

Our emergency rooms are open every hour of every day and are walk-in. Go to the nearest one, and if another emergency department is closer to you, that one is the right answer tonight.

Some eye injuries need an eye specialist, and the way to reach one is through an assessment that can decide it is needed. Being seen is the route, not a detour from it.

If you are unsure, come in — this list is not exhaustive and you are not expected to examine your own eye.

Questions people actually ask

I got something in my eye and blinked it out. It still feels scratchy. A scratch can remain after the object has gone, and it is worth being seen — particularly if it is painful, watering, or sensitive to light.

I wear contact lenses. Say so at the desk, immediately. It changes what is considered and how quickly. If a lens is still in an injured or chemically exposed eye, mention it at once rather than trying to work it out yourself.

How long do I really have to flush? At least fifteen minutes, per ACEP. Use a clock, because it will feel much longer than it is.

It is just a black eye. Cold compress without pressure, and be seen if there is any change in vision, any bloodshot appearance, any leakage, or severe pain.

Can I put eye drops in? Not before it has been assessed, unless they were prescribed for this. Nothing goes in an injured eye except water for a chemical exposure.

My welding or grinding has left my eyes burning hours later. Be seen. Delayed burning after that kind of work is a recognised pattern and it is not something to sleep off.

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Chemicals: flush for at least 15 minutes. A cut: do not wash it. Embedded: do not touch it. Any vision loss: come now. Both of our emergency rooms are open 24 hours a day, every day of the year — walk in, no appointment and no referral. Find your nearest emergency room →

Related reading: which door do you need · hot pavement burns

Sources

44. Eye Emergencies — Know When To Go — American College of Emergency Physicians. https://www.emergencyphysicians.org/article/know-when-to-go/eye-emergencies
59. Poisons, Chemicals & Smoke Inhalation — Know When To Go — American College of Emergency Physicians. https://www.emergencyphysicians.org/article/know-when-to-go/poisoning

This article is general information, not a diagnosis. It gives no doses. If you are unsure, come in — this list is not exhaustive and you are not expected to assess your own eye. If it might be an emergency, treat it as one and call 911.