Types of Eye Injury

Types of Eye Injury

There are a few types of eye injury which one should be aware of which can be caused by sharp edge objects, welding, grinding, chemical and blow-out fracture.

 

1) Corneal Abrasion

corneal-abrasion

Any object with a sharp edge (even finger nail, leaf or paper) can scrape the skin (called the epithelium) of the cornea causing a cornea abrasion. The epithelium takes an average of 5 to 10 days to heal back and until then, the patient will suffer symptoms of pain, discomfort, and feeling of something in the eye, watering, blurred vision and light sensitivity.

The eye needs to be padded with an antibiotic ointment for the first 1-2 days and then antibiotic ointment 2-3 times a day for at least 2 weeks. There is a risk of the abrasion to recur again ( a condition called corneal erosion) and as such, it is advisable to continue the ointment on a nightly basis for at least 6 months to prevent it.

2) Corneal Foreign Body

corneal-foreign-body

During welding or grinding, there is usually a lot of debris and sparks emitted and can easily hit the eye. As the velocities of these particles are generally slow, they do not penetrate the eye but gets embedded onto the cornea. They cause discomfort, watering and red eyes.

The particles need to be removed or else they will get infected. After removal, there will always be a scar at the injury site.

 

3) Penetrating Foreign Body

penetrate-foreign-body

When an object which is sharp enough and traveling fast enough hits the eye, it will penetrate the eye and lodge inside. In such cases, the prognosis is poor as there will have been a lot of internal damage.

Urgent surgery is required to remove the object and repair the wound.

 

4) Hyphaema (blood in the eye)

 

blood-in-the-eye

When the eye is hit hard enough, the blood vessels in the eye may bleed resulting in a hyphaema. This may cause the eye pressure to rise resulting in glaucoma. The patient should avoid all strenuous activities and have strict bed rest to prevent further bleeding (which can happen within the first 3-4 days of the injury).

The blood usually takes between 7-14 days to subside and the vision may not return to normal as there may be damage to the lens or pupil causing problem with focusing. There is also a risk of glaucoma and this patient should have a yearly check up for life.

 

5) Chemical Injury

chemical-injury

Fluids used for in any industry as either acid or alkali. Both are damaging to the eye and the higher the concentration, the more severe the injury. Even toilet cleaner or household bleach can cause severe damage to the eye and should therefore be kept away from children’s hands.

The eye must be irrigated with clean running water or at least 5 minutes to wash away as much chemical as possible. The patient has to be admitted to a hospital to allow the eye doctors to apply medication, lubrication and vitamins to encourage the eye to heal. Sometimes in very severe cases, the scarring is so extensive that the patients do not regain their vision.

6) Blow-out Fracture

blowout-fracture

When a blunt trauma (such as a punch) is of sufficient strength, the impact can cause the orbital floor to fracture. Some fractures can cause one of the eye muscles to be trapped resulting in the eye not being able to move fully causing double vision.

Surgery is required to repair the fracture and free up the eye muscle.

To conclude, we believe that prevention of eye injury can save many unnecessary suffering. People working in hazardous conditions must remember to wear their protective goggles at all times while welder must wear their masks.Sportsman can now choose from a variety of protective eyewear which offer protection and yet remain stylish.

Remember, prevention is better than cure.

Download Teleme’s mobile app and consult an Eye Specialist

Dr. Lee Mun Wai

Dr. Lee Mun Wai

Ophthalmologist

 

 Dr. Adrian Tey

Dr. Adrian Tey

Ophthalmologist

 

Dr. Premadeva

Dr. Premadeva

Ophthalmologist

 

Eye Injury

Eye Injury

Our eyes occupy less than 5% of the area of the face but yet the eye gets injured in over 60% of the time when there is trauma to the face region. Fortunately, the eye has its own protective mechanism thus reducing the severity of any injury.

Eyelid

The eyelids close by reflex to protect the eye whenever the eye senses an object approaching the eye.

Rotation of the Eyeball

When the eyelid shuts, the eyeball automatically rotates/rolls upwards and outwards so that the cornea (the transparent part of our eye) is no longer facing the front but safely tucked away.

 

cutting-onion

Image source: Mashed

Eyelashes

The eyelashes trap particulate objects such as dust or smoke preventing it from entering the eye.

Tears

The tear gland secretes large amounts of tears whenever a naxious substance or foreign body touches the eye so as to “wash out” and dilute the offending danger (think of the time when you cut hot chilli/onion or having an eyelash in your eye!)

Bony Orbit

The skull has 2 eye sockets called the orbit in which the eye sits in and protects the eyeball from side impact. Only objects smaller than a squash ball can penetrate the orbit socket while larger objects such as a fist or tennis ball cannot damage the eyeball.

 

protective-eyewear

Image source: All About Vision

As the eyeball is one of the most sensitive organs in our body, any injury causes severe symptoms of pain, light sensitivity, tearing and blurred vision.  It becomes almost impossible to work or function normally until the eye heals completely due to these symptoms.

Causes of Eye Injuries

Eye injury is one of the commonest causes of blindness in the developing world due to accidents in the occupational workplace which involves hammering, grinding, staple-guns, welding or use of strong chemicals such as acid or alkali.

 

playing-squash

Image source: Club Towers

Sporting injury is also common especially with a squash ball or shuttlecock being hit directly at the eye. The amount of injury is related to the size (mass) and velocity of the object as kinetic energy = mv2. The faster the object hits the eye, the greater the damage inflicted.

Sometimes, even a leave or twig can scratch the eye when we are not careful while gardening. Adult sometimes get their eyes scratched by the little fingers of their small child or  baby who is often fascinated by the moving eye. Note that they also like to grab your spectacles off your face!

Falls or motor vehicle accidents or criminal assaults are other causes of eye injuries.

Next up on Healthtips, Types of Eye Injury.

Download Teleme’s mobile app and consult an Eye Specialist today

 

Dr. Lee Mun Wai

Dr. Lee Mun Wai

Ophthalmologist

 

 Dr. Adrian Tey

Dr. Adrian Tey

Ophthalmologist

 

Dr. Premadeva

Dr. Premadeva

Ophthalmologist

 

Pregnancy and Your Vision

Pregnancy and Your Vision

Pregnancy is a time of joy when the mother will be carrying and nourishing her child for the next 9 months. The duration of pregnancy is divided into 3 phases called trimester (1st, 2nd and 3rd trimester) each of which consists of 3 months.

Throughout pregnancy, there are changes in the hormone levels in the body which are essential to support the growth and development of the baby. These hormones also cause change in the mother’s metabolism, blood circulation, body size and a whole host of other symptoms such as tiredness, body swelling, mood changes and appetite changes which we are familiar with.

Pregnancy also affects the vision but only in a very minor way and may not even be apparent to most mothers.

Changes in refraction

The curvature of the cornea may change during pregnancy and as such may affect the vision as there may be either an increase (or rarely decrease) in the refractive error such as short or long sightedness. This is due to fluid retention at the lens and cornea causing a change in refraction.

Fortunately, this is temporary and the refractive error should return to the previous level within 1 month after the birth of the child.
As such, there is no need to change prescription of your glasses during pregnancy as the effect is only temporary.

 

Dry Eyes

rub-eyes

Image source: Shutterstock

The eyes can get more tired during pregnancy for 2 reasons. Firstly, the mother’s sleep may be disturbed as she finds it difficult to get into a comfortable sleeping position as her abdomen gets larger as the baby grows. Secondly, the cornea tends to get drier and contact lens wearing may be more uncomfortable and the eyes feel gritty.

This is easily solved by using eye lubricants on a regular basis (between 2-6 times per day) during pregnancy. If you wear contact lenses, you could apply preservative-free lubricants while wearing them or simply wear them for shorter periods.

The amount of dryness is related to the number of hours wearing the contact lenses. If this is too much trouble, just wear glasses during the pregnancy.

 

Diabetic Retinopathy

Diabetes becomes more difficult to control during pregnancy. As such, the eye is at risk of developing diabetic retinopathy and retina haemorrhages during pregnancy. It is very important that pregnant diabetic visit to the ophthalmologist (eye doctor) more frequently during pregnancy.

A general rule is a visit at the beginning of each trimester and monthly during the last trimester until 1 month after the birth of the child.

 

Hypertensive Retinopathy

In rare occasion, pregnancy can cause the blood pressure to rise very high in a condition called eclampsia. This is dangerous to the baby’s development and the mother’s health. In the event of uncontrollable high blood pressure, the mother is at risk of developing neurological (brain) strokes, kidney and heart failure as well as hypertensive retinopathy (haemorrhages in the retina) or strokes in the eye called vein occlusion which can cause blindness.

pregnant-lady-visit-to-doctor

Image source:  Below the Belly Button

Summary

  • Vision changes can occur during pregnancy but fortunately these changes are temporary and in most cases, the vision returns to normal within 1 month after birth.
  • If you wear glasses or contact lenses, do not change the prescription until after you have had the baby.
  • Dry eye symptoms are common and can be easily treated with lubricant eye drops. Use preservative-free eye drops if you are wearing contact lenses.
  • Mothers who are on treatment for diabetes or hypertension should have their eyes checked during pregnancy as they may develop sight-threatening complications.

Download Teleme’s mobile app and consult an Ophthalmologist

 

Dr. Lee Mun Wai

Dr. Lee Mun Wai

Ophthalmologist

 

 Dr. Adrian Tey

Dr. Adrian Tey

Ophthalmologist

 

Dr. Premadeva

Dr. Premadeva

Ophthalmologist

 

Your Child’s Vision: Refractive Errors (The Need To Wear Glasses)

Your Child’s Vision: Refractive Errors (The Need To Wear Glasses)

Here we have come to the last part of the series Your Child’s Vision. In this post, we’ll explain about Refractive Errors (the need to wear glasses).

In normal vision, light enters the eye and the image is focused clearly at a single point on the retina (the light sensitive area similar to the film of a camera) at the back of the eye.  Refractive errors result from abnormality of either the length of the eyeball or curvature of the front of the eye called the cornea.

When a refractive error exists, the image is not in focus and 3 situations can arise.

 

1. Myopia (short-sightedness)

Image source: Coolwinks

The image is focused in front of the retina because either the eyeball is too long or the cornea too curved.  The child can see near objects but distant objects appear blurred.  This is the commonest refractive error is Asians and usually manifests between the ages of 6 to 16 years of age.  There is a correlation between short-sightedness and high intelligence, excessive reading, excessive playing of computer or handheld games and not spending enough time outdoors to see distant objects.

 

2. Hyperopia (long-sightedness)

Image source: Coolwinks

The image is focused behind the retina because the eyeball is too short.  Both far and near objects appear blurred although the distant vision is slightly less blurred.

3. Astigmatism

Image source: Coavision

 

The image is focused at 2 points on the retina and objects at all distances appear blurred and distorted. Astigmatism is due to unevenness of the cornea.

A child who develops a refractive error will require spectacle correction to be able to see clearly. This is very important for the child visual development (especially if the child is below the age of 9 years) because not wearing spectacles can lead to amblyopia.

 

When and how often should a child have the eyes checked?

 

It is recommended that children should have their first eye examination at the age of 3 years and again just before the start of school (around 6-7 years old) by either the eye doctor, orthoptist or optomterist.

The eye test should include:

  • Measurement of any refractive errors (shortsighted, longsighted or astigmatism)
  • Eye movement assessment and detection of any squint
  • 3D vision (depth perception) assessment

Risk-free children can have the eyes checked every 2 years while children who wear spectacles should have their eyes checked every year by the optometrist as the prescription may change within this period.

 

 

Age No Symptoms & risk-free At risk children
Birth to age 6 years

One check by the age of 6 years. An eye check at age 3 years is optional

One eye check by the age of 1 year & as recommended thereafter

Ages 6 to 18 years Every 2 years Every year
Children who wear glasses Every year Every year

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Ophthalmologist (Paediatric)

 

Your Child’s Vision: Common Eye Problems In Children

Your Child’s Vision: Common Eye Problems In Children

If you’ve read about the 1st part of Your Child’s Vision Series (Your Child’s Visual Milestones). It’s understood that children from 2 years old onwards are the age group that usually manifest common eye problems which we are going to talk about in this post.

The following are common eye problems which can be found in children.

 

A. AMBLYOPIA  (also known as ‘lazy eye’)

Amblyopia occurs because the eye is not able to reach the full potential of its visual development as the eye is not used (in other words, neglected) by the child who prefers to use the other normal eye to see.  This is because the image seen with the affected eye is not as clear as the normal eye and the child prefers to see with the normal eye.

Any disease which blurs or blocks the vision during childhood will result in amblyopia.

Causes include:

  • Refractive errors which have not been corrected with spectacles
  • Squints (the eye which is squinting will be neglected and become amblyopic)
  • Congenital cataract (cataracts which have formed at birth although this is rare)
  • Cornea scarring due to infection or injury (also very rare)

 

In order to reduce the possibility of amblyopia, it is important to diagnose the condition and intervene early. A child with amblyopia may have no visual complaints because the child may be using the other good eye which has normal vision. For this reason, it is absolutely vital a child (who is at risk) must be assessed using appropriate testing techniques and examined by an eye doctor, optometrist or orthoptist to screen for amblyopia.

Amblyopia can be reversed if the situation is detected early during the visual development period (until the age of 9 years).  The earlier amblyopia is detected, the greater is the child’s chance of recovery.  Once a child is diagnosed to have amblyopia, the first plan of action is to treat the underlying cause (if any) such as shortsightedness using spectacles or congenital cataract using surgery before starting amblyopia therapy.

 Image source: huffingtonpost

The amblyopia therapy involves patching the good (i.e: normal) eye so that the amblyopic eye will be used by the child and hence stops it from being neglected.  The duration for patching the normal eye varies between 1 to 6 hours per day depending on the regime used and the severity of the amblyopia. It is important to use the lazy eye during the patching period by doing hand-eye exercises such as drawing, copying and colouring.

 

Compliance with therapy is the single most important factor determining a successful outcome.  It requires full cooperation of the child and parents as well as strict supervision of the eye doctor or orthoptist to ensure good results.  Visual improvement can sometimes be measured after only 1 month of therapy.  Patching can be stopped when the vision has improved to almost normal (the lazy eye can never reach 100% normal so at best 90% of normal can be considered excellent result), or when there is no further visual improvement especially when the child has reached 9 years of age.

 

B. SQUINTS (also known as ‘cock-eye)

Image source: Allaboutvision

Humans possess two eyes which give us binocular vision and hence the ability to judge depth and distance in 3-dimension. In the normal person, the 2 eyes are parallel to each other and move together when we look from one object to another.

Image source: SightMD

A squint is present when the 2 eyes are not aligned parallel to each other. When looking ahead, the squinting eye (or cock eye) is either deviated inwards or outwards and is known as a convergent or divergent squint respectively.

When a child has a squint, the vision in the squinting eye will be suppressed and the child will prefer to use the normal eye all the time. This will lead to amblyopia (lazy eye) in the squinting eye. Squints usually appear between the ages of 1-3 years.

Treatment of squints involves patching the normal eye to reverse the amblyopia (see treatment of lazy eye above) and then plan to perform squint surgery to align the eyes so that they become parallel again. Some squints do not need surgery and eye fusion exercises together with spectacles will be sufficient to treat the squint.

Successful treatment will allow the child to look normal (so that he/she will not be teased at school) and restore some degree of binocular vision for the child.

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Download Teleme App for FREE and consult a specialist today on your child’s vision care and treatment:

 

Ms. Melanie Yeoh

Ms. Melanie Yeoh

Orthoptist (Lazy eye /Squint)

 

Dr. Tsiang Ung

Dr. Tsiang Ung

Ophthalmologist (Paediatric)

 

 Dr. Lee Mun Wai

Dr. Lee Mun Wai

Ophthalmologist (Retina)

 

Your Child’s Vision: Your Child’s Visual Milestones

Your Child’s Vision: Your Child’s Visual Milestones

At birth, the infant’s visual function is not fully developed but continues to develop in the first few years of life.  It is therefore important to monitor your child’s vision as he/she grows so that any abnormalities can be detected and treated early.

The visual milestones (see Table below) are a useful guide to monitor your child’s visual development. If the child does not appear to follow the milestones or if you have any concern, do consult an eye doctor, optometrist or orthoptist for a more thorough eye examination.

Children’s Visual Milestones

Age Visual ability
0-3 months At birth, the vision is poor (only in the range of hand movements or count fingers).  The newborn infant will initially choose to look at light sources such as a torch and only begin to develop eye contact with adults from around the age of 6-8 weeks.  The infant will soon be able to follow large objects which move slowly within his/her environment.
3-6 months The child will now begin to reach objects with his/her hands especially brightly coloured and larger objects.  The eyes will begin to move more widely and with less head movement.  The child will also be learning to grasp with his/her hands and also watch the parent’s face when being talked to.
6-12 months The child is now able to see smaller objects such as ‘100s and 1000s’, bread crumbs or sweets.  The child will try to pick them up and place them in his/her mouth!  The child can also interact with the parents as he/she will be interested in simple pictures in books or drawn for him/her.  He/she will be able to fixate and follow objects of interest such as his/her favourite toy.
12-18 months The child is able to recognize people’s faces and pictures. As the child begins to crawl, he/she is able to know the way around the house.  At this age, the child’s vision can be estimated by putting ‘100s and 1000s’ in your palm and watching the child reach for them.
18-24 months The child now becomes interested in picture or cartoon books, and may even recognize them as representations of real objects.  The child’s vision can be estimated by rolling STYCAR balls of decreasing sizes at around 3 m in front of the child and the child should be able to follow the balls movements.  The vision corresponds to the smallest ball that the child is able to see moving.  The child’s vision can also be assessed using Forced Preferential Teller Acuity Cards or Cardiff picture cards if the child is cooperative.
2 years onwards The child’s vision is almost at its peak development but continues to improve until the age of 7-9 years old. The vision can now be tested accurately using picture recognition and matching technique with Kay or Cardiff picture cards.  All children should be screened by the age of 3 years because squints and amblyopia (lazy eye) usually manifest by this age group.

Children at risk

In most cases, the child’s vision develops without any problems. However, in some children, there may be problems during the early development of their vision and this may affect the development of the child’s other milestones such as speech (as the child cannot see words to learn) or motor development (as the child does not have the confidence to see where he/she is crawling or walking).  The child may also have difficulty bonding with the mother as he/she may not be able to see the mother’s facial expressions.

Baby image created by Yanalya – Freepik.com

Children at risk include those:

  • Who have someone in the family with eye diseases such as congenital cataract, squints or high refractive errors which may be hereditary in nature
  • Born to mothers who were ill during pregnancy (especially during the 1st trimester) with infections such as rubella, cytomegalovirus or herpes virus
  • Born prematurely (especially less than 32 weeks gestation)
  • With low birth weight (especially less than 1.5kgs)
  • Who have Down’s syndrome or are educationally subnormal

Download Teleme App and consult a specialist today on your child’s vision care and treatment:

 

Ms. Melanie Yeoh

Ms. Melanie Yeoh

Orthoptist (lazy eye /squint)

 

Dr. Tsiang Ung

Dr. Tsiang Ung

Ophthalmologist (paediatric)

 

 Dr. Manoharan Shunmugam

Dr. Manoharan Shunmugam

Ophthalmologist (retina)

 

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