Foreign object in eye, corneal abrasion, and welder's flash clinical first aid¶

The transparent human cornea is the most densely innervated tissue on the surface of the body, supplied by roughly 7,000 nociceptive nerve endings per square millimeter via the ophthalmic branch of the trigeminal nerve (cranial nerve V1). Because this nerve density is 300 to 600 times greater than that of human skin, even a microscopic speck of windblown grit, a superficial fingernail scratch, or a few seconds of unshielded ultraviolet welding arc exposure produces agonizing foreign-body pain, involuntary eyelid spasm (blepharospasm), and profuse reflex tearing.

At the same time, high-velocity mechanical activities such as striking metal against metal, using a rotary angle grinder, or operating a string trimmer can fire a tiny metallic projectile completely through the cornea or sclera into the interior of the eyeball with deceptively mild initial discomfort. Knowing how to screen for an open globe rupture or intraocular foreign body before touching the eyelids, how to safely evert the upper eyelid to flush out a hidden particle trapped in the subtarsal sulcus, and why contact lens wearers and home numbing drops carry severe risks of permanent corneal blindness is critical for preserving sight.

Faça isso agora¶

1. Tell the person to stop rubbing their eye immediately and sit them down in a dimly lit area. Rubbing an eye that contains a sharp particle of glass, metal, rust, or silica grinds the fragment deeper across the delicate corneal epithelium like sandpaper, and pressing on a punctured eyeball can extrude intraocular fluid and the iris out of the wound.
2. Inspect the eye under gentle light for "Open Globe" or high-velocity trauma red flags BEFORE attempting to flush or pull on the eyelids. If the injury occurred while hammering metal on metal, grinding, chiseling, or near an explosion, OR if you see a teardrop-shaped or peaked pupil, blood pooling in the front of the eye (hyphema), a protruding dark gelatinous bead on the surface, or an object stuck in the clear cornea, DO NOT flush the eye and DO NOT touch the eyelids.
3. Ligue para o número de emergência local ou vá imediatamente para um pronto-socorro com atendimento oftalmológico para qualquer suspeita de lesão penetrante, impacto de metal em alta velocidade ou perda de visão. Disque 911 nos Estados Unidos e Canadá, 112 na União Europeia, 999 no Reino Unido, 000 na Austrália ou verifique o diretório de números de emergência. Proteja um olho perfurado ou rompido imediatamente com uma cúpula protetora rígida (como uma proteção ocular de metal Fox ou o fundo de um copo de papel colado na testa e na maçã do rosto) sem colocar qualquer pressão de gaze contra o globo ocular.
4. Remove contact lenses immediately ONLY if the injury is a simple low-velocity dust speck, scratch, or UV flash and the lens slides off easily. Never leave a contact lens in an abraded or irritated eye, as Pseudomonas aeruginosa bacteria trapped beneath the lens can melt through the cornea within 24 hours. If a lens is stuck, wait until you gently irrigate the eye with sterile saline so it floats free.
5. Flush low-velocity loose dust, eyelashes, sand, or sawdust out of the eye using a gentle continuous stream of sterile saline or clean lukewarm tap water. Tilt the person's head to the side with the injured eye facing downward so water flows from the inner corner (near the bridge of the nose) outward across the temple, preventing debris from washing into the uninjured eye.
6. **Mantenha ambos os olhos fechados e descansados ​​para suspeitas de abrasões na córnea ou flash de soldador ultravioleta (fotoceratite) e NUNCA coloque sobras de colírios anestésicos nos olhos em casa. ** Como os dois olhos se movem juntos (olhar conjugado), descansar com ambos os olhos suavemente fechados em um quarto escuro impede que a pálpebra superior raspe o defeito cru da córnea. Nunca aplique tapa-olhos de compressão apertada e nunca use colírios anestésicos prescritos (proparacaína ou tetracaína) em casa.

Árvore de decisão de emergência para corpos estranhos oculares agudos e lesões superficiais¶

flowchart TD
    Start["Acute Eye Pain, Foreign Body Sensation, or Flash Burn"]
    StopRub["Instruct Patient: DO NOT RUB OR PRESS ON THE EYE"]
    HighVel{"High-Velocity Mechanism OR Open Globe Signs?<br/>(Hammering metal, grinding, teardrop pupil, hyphema, embedded corneal shard)"}
    ShieldGlobe["OPEN GLOBE / INTRAOCULAR FOREIGN BODY PROTOCOL<br/>1. DO NOT flush, DO NOT evert lid, DO NOT apply pressure<br/>2. Tape a rigid paper cup or Fox eye shield over bony orbit<br/>3. Keep patient seated at 30 to 45 degrees (nothing by mouth)<br/>4. Transport immediately to Emergency Ophthalmology + Orbital CT"]
    UVCheck{"History of Unshielded UV Exposure 6 to 12 Hours Ago?<br/>(Arc welding, snow/glacier reflection, tanning bed, germicidal UVC lamp)"}
    UVCare["ULTRAVIOLET PHOTOKERATITIS (WELDER'S FLASH / SNOW BLINDNESS)<br/>1. Move to dark room and remove contact lenses immediately<br/>2. Apply cool damp cloth over gently closed eyelids<br/>3. Instill preservative-free artificial tears or lubricating ointment<br/>4. Seek medical evaluation for cycloplegic drops and oral analgesia"]
    LooseFB["Low-Velocity Loose Foreign Body or Surface Scratch<br/>(Windblown dust, sand, eyelash, sawdust, fingernail, tree branch)"]
    Irrigate["Gentle Ocular Irrigation Protocol<br/>1. Tilt head so injured eye is lowest (flush inner-to-outer corner)<br/>2. Irrigate with sterile normal saline or lukewarm tap water<br/>3. Remove contact lens once lubricated"]
    CheckClear{"Did Irrigation Remove the Particle?"}
    EvertLid["Inspect & Evert Upper Eyelid (Subtarsal Sulcus)<br/>1. Ask patient to look down while gently pulling upper lashes forward/up<br/>2. Sweep visible loose speck off inner lid with wet cotton swab<br/>3. NEVER touch or scrape a speck stuck on the clear cornea"]
    PostAbrasion["Corneal Abrasion & Rust Ring Screening<br/>1. Do NOT apply a tight pressure eye patch<br/>2. Urgent clinic visit for fluorescein staining & rust ring removal<br/>3. Mandatory antipseudomonal antibiotic drops if contact lens wearer"]

    Start --> StopRub
    StopRub --> HighVel
    HighVel -->|Yes: High-Velocity or Globe Rupture| ShieldGlobe
    HighVel -->|No: Low-Velocity Surface Issue| UVCheck
    UVCheck -->|Yes: Bilateral Delayed Pain & Photophobia| UVCare
    UVCheck -->|No: Unilateral Grit or Scratch| LooseFB
    LooseFB --> Irrigate
    Irrigate --> CheckClear
    CheckClear -->|No: Still Feels Under Upper Lid| EvertLid
    CheckClear -->|Yes: Particle Flushed Out| PostAbrasion
    EvertLid --> PostAbrasion

Comparando corpos estranhos oculares, abrasões da córnea e queimaduras ultravioleta¶

Como um corpo estranho aprisionado, uma abrasão corneana residual, uma úlcera corneana precoce e uma queimadura ultravioleta compartilham a tríade característica de dor de corpo estranho, lacrimejamento (epífora) e sensibilidade à luz (fotofobia), distinguindo-os pelo cronograma de exposição, lateralidade e aparência física orienta o tratamento seguro.

Step 1: Screening for an Open Globe or Intraocular Foreign Body¶

Antes de derramar água em um olho machucado ou puxar uma pálpebra, você deve gastar 15 segundos descartando uma lesão penetrante no globo (globo aberto) ou um corpo estranho intraocular de alta velocidade (IOFB). Realizar a eversão da pálpebra ou pressionar um pano sobre um globo ocular rompido comprime o humor vítreo gelatinoso e o tecido uveal através da laceração, causando a perda permanente do olho.

The 7 red flags of an Open Globe or Intraocular Foreign Body¶

Do NOT irrigate, do NOT remove any protruding object, and do NOT touch the eyelids if any of the following are present:

1. High-velocity mechanism: The person was hammering metal on metal, using a cold chisel, operating a high-speed grinder, wire wheel, drill, or lawn edger/weed trimmer, or was exposed to a blast or gunshot.
2. A peaked, teardrop-shaped, or irregular pupil: When the cornea or limbus (the border where the clear cornea meets the white sclera) is punctured, aqueous humor leaks out and the colored iris plugs the hole from the inside, pulling the round pupil into a pointed teardrop shape whose tip points directly toward the site of perforation.
3. A visible dark bead or blister on the cornea or sclera: Prolapsed iris or choroidal tissue looks like a tiny dark brown or black grape seed sitting on the surface of the eye. Never mistake this for a piece of dirt and never try to wipe it off.
4. Hyphema (blood pooling inside the front chamber of the eye): Visible bright red or dark reddish-black blood layering out in front of the colored iris indicates severe blunt or penetrating intraocular trauma.
5. A "bullous" 360-degree bloody conjunctiva: When the white of the eye is completely ballooned up with dark red subconjunctival hemorrhage all the way around the cornea, it frequently hides a deep scleral rupture underneath.
6. Collapse or asymmetry of the anterior chamber: Looking at the injured eye from the side and comparing it to the uninjured eye reveals that the space between the clear cornea and the colored iris is either completely flat (cornea touching iris) or abnormally deep.
7. Visible embedded shard on the clear cornea: If a piece of metal, glass, or wood is stuck directly into the clear dome of the cornea over the iris or pupil, do not try to flush or brush it off.

How to shield a suspected Open Globe in the field¶

If any of the 7 red flags above are present: * Fashion a rigid vaulted eye shield: Use a commercial perforated aluminum Fox eye shield or cut the bottom 4 centimeters (1.5 inches) off a disposable paper or foam drinking cup. * Tape the rim strictly to the surrounding facial bones: Place the rim of the shield or paper cup so it rests on the bony brow ridge (supraorbital rim) above and the cheekbone (zygomatic arch) below, arching completely over the eye without touching the eyelids or eyeball. Secure it with strips of tape running diagonally from the forehead to the cheek. * NEVER place a gauze pad underneath the shield: Stuffing folded gauze under an eye shield turns it into a pressure dressing that presses down on the ruptured eyeball. * Mantenha o paciente sentado em uma inclinação de 30 a 45 graus, calmo e NPO (nada por via oral): Evite vomitar, tossir ou curvar-se, pois o esforço de Valsalva aumenta a pressão intraocular. Mantenha o paciente em jejum caso seja necessária anestesia geral de emergência para reparo cirúrgico do globo.

Step 2: Safe removal of a loose surface foreign body¶

Once you have confirmed the injury was caused by a low-velocity particle (such as windblown dust, sand, sawdust, an eyelash, or an insect) and there are no signs of globe penetration, you can safely flush the ocular surface.

Technique A: Gravity-assisted ocular irrigation¶

1. Position the patient with the injured eye facing downward: Have the person sit or lie down and tilt their head to the side so the injured eye is lower than the uninjured eye. Place a folded towel against their temple or hold a kidney basin under their cheek.
2. Hold the eyelids gently apart against the bony orbital rims: Using your thumb and index finger, gently hold the upper eyelid upward against the bony brow ridge and the lower eyelid downward against the cheekbone. Never press your fingers against the soft eyeball itself.
3. Pour a slow, steady stream of sterile normal saline (0.9% sodium chloride), commercial sterile eyewash, or clean lukewarm tap water: Hold the bottle or cup 2 to 5 centimeters (1 to 2 inches) above the inner corner of the eye (medial canthus) near the bridge of the nose, letting the water flow smoothly across the surface of the eye and drain off the outer corner (lateral canthus).
4. Have the patient roll their eye in all directions during flushing: Ask the person to look up, down, left, and right while the water flows so the fluid reaches deep into the upper and lower conjunctival sacs (fornices).

Technique B: Inspecting the lower lid and everting the upper eyelid¶

If flushing does not wash the particle out and the person still feels a sharp scratch under the upper lid every time they blink, the particle is almost certainly lodged in the subtarsal sulcus, a shallow horizontal groove located 2 millimeters (0.08 inches) inside the inner surface of the upper tarsal plate.

1. Check the lower eyelid sac (inferior fornix) first: Ask the patient to look up toward the ceiling while you gently pull the lower eyelid skin downward against the cheekbone. If you see a speck resting on the pink inner lining (palpebral conjunctiva), gently touch it with the tip of a clean cotton swab moistened with sterile saline so it sticks to the wet cotton and lifts away.
2. Evert (flip) the upper eyelid using the cotton-swab fulcrum method:
3. Step 1: Stand in front of the seated patient and instruct them to look continuously down at their feet while keeping their head level. Looking down relaxes the levator palpebrae superioris muscle, which is required to flip the rigid tarsal plate.
4. Step 2: Grasp the upper eyelashes gently between the thumb and index finger of one hand and pull the upper lid slightly forward (away from the eyeball) and downward.
5. Step 3: With your other hand, place the wooden or plastic shaft of a cotton-tipped applicator horizontally across the outer skin of the upper eyelid at the upper crease (roughly 1 centimeter / 0.4 inches above the lash line, at the top edge of the firm tarsal plate).
6. Step 4: Press very lightly downward on the applicator shaft as a hinge while pulling the eyelashes upward and backward over the shaft. The rigid tarsal plate will fold neatly inside-out, exposing the pink subtarsal sulcus.
7. Step 5: Hold the lashes gently against the brow with your thumb while the patient continues looking down. If you see a speck of grit, dust, or an eyelash sitting on the flipped inner eyelid, gently dab it off using a saline-moistened cotton swab.
8. Step 6: To return the eyelid to its normal position, simply release the eyelashes and ask the patient to look up toward the ceiling and blink once. The lid will snap smoothly back into place.

Abrasões da córnea, anéis de ferrugem e o perigo das lentes de contato¶

Mesmo depois que um corpo estranho solto é eliminado com sucesso, ou após um arranhão direto da unha, galho de árvore, borda de papel ou escova cosmética de um bebê, o paciente frequentemente continua a sentir como se algo ainda estivesse preso no olho. Essa sensação fantasma de corpo estranho ocorre porque a pálpebra superior roça as terminações nervosas expostas e desnudas de uma abrasão da córnea a cada piscada.

Como as abrasões da córnea cicatrizam e por que os anéis de ferrugem precisam de um médico¶

The superficial layer of the cornea (the stratified squamous corneal epithelium) regenerates remarkably fast: healthy basal epithelial cells surrounding a scratch flatten out, slide across the bare basement membrane like an amoeba, and undergo mitosis to resurface most small abrasions within 24 to 48 hours without leaving a scar, provided Bowman's layer and the underlying corneal stroma were not penetrated.

However, two specific foreign-body scenarios prevent normal healing and require same-day professional ophthalmologic care:

1. Corneal metallic foreign bodies and Ferrous Rust Rings: When a hot microscopic fleck of iron or steel from an overhead car repair, brake rotor, or grinding wheel embeds in the cornea, tear film electrolytes begin oxidizing the iron within 2 to 6 hours, creating a circular orange-brown ferrous rust ring that chemically infiltrates the surrounding corneal epithelium and anterior stroma. Even if the central metal speck falls out, the toxic rust ring acts like a persistent foreign body that prevents epithelial closure, triggers sterile white blood cell infiltration (iridocyclitis), and leaves a permanent opaque visual scar over the pupil unless a clinician numbs the eye under a slit-lamp microscope and gently burrs away the oxidized tissue using a low-speed ophthalmic Alger brush.
2. Organic and vegetative trauma (Fungal Keratitis risk): Scratches caused by tree branches, pine needles, rose thorns, landscaping mulch, or agricultural stalks inoculate filamentous fungi (Fusarium and Aspergillus) or Acanthamoeba into the corneal defect. Vegetative corneal abrasions must never receive steroid drops and require close ophthalmologic monitoring.

Why we no longer apply tight pressure eye patches to corneal abrasions¶

For decades, first aid courses and emergency departments routinely taped a tight folded gauze pad (pressure patch) over an abraded eye to keep the eyelid from moving. Modern randomized controlled ophthalmology trials (including Cochrane systematic reviews) have established that routine pressure patching of corneal abrasions is no longer recommended and can be harmful:

• Patching does not speed up epithelial healing rates or reduce pain in small-to-moderate abrasions (< 10 millimeters squared).
• A warm, dark, closed patch raises the temperature of the ocular surface and cuts off oxygen tear exchange, creating an incubator that promotes rapid bacterial proliferation.
• Patching a contact lens wearer or an organic vegetative scratch is strictly contraindicated, as it dramatically increases the risk of a devastating Pseudomonas or fungal corneal ulcer.
• Putting on an eye patch immediately eliminates binocular depth perception (stereopsis), increasing the risk of tripping, falling, or motor vehicle collisions.

Instead of a tight patch, have the patient rest comfortably in a dimly lit room with both eyes gently closed, wear dark wrap-around sunglasses when walking, and use prescribed ophthalmic antibiotic ointment (such as erythromycin ointment for non-contact-lens wearers) which acts as a thick liquid cushion between the eyelid and the abraded cornea.

The contact lens emergency: Pseudomonas aeruginosa¶

If a person who wears soft or rigid contact lenses develops a corneal abrasion, foreign-body scratch, or red painful eye:

• Remove the contact lens immediately and place it in its storage case (bring the lens and case to the eye doctor in case microbiological cultures are needed).
• Mandatory antipseudomonal antibiotic drops: Contact lens wear alters the tear film and traps Pseudomonas aeruginosa, an aggressive Gram-negative bacterium that secretes elastase and alkaline protease enzymes capable of liquefying and perforating the human cornea within 24 to 48 hours. Standard erythromycin eye ointment does not cover Pseudomonas; contact lens wearers with a corneal abrasion must be prescribed topical antipseudomonal fluoroquinolone eye drops (such as moxifloxacin, ciprofloxacin, or ofloxacin) or tobramycin by a clinician, must never have their eye patched, and must be re-examined within 24 hours.
• Do not resume wearing contact lenses until a clinician confirms the corneal epithelium has completely healed and the patient has been symptom-free off drops for several days.

Welder's flash and snow blindness (Ultraviolet Photokeratitis)¶

Ultraviolet photokeratitis (commonly called welder's flash, arc eye, or snow blindness) is an acute radiation burn of the superficial corneal epithelium and conjunctiva caused by unprotected exposure to short-wavelength ultraviolet rays, primarily UVB (280 to 315 nanometers) and UVC (100 to 280 nanometers).

Fontes comuns de fotoceratite UV¶

• Soldagem a arco industrial (corte MIG, TIG, eletrodo e plasma): Observar um arco de soldagem não blindado de 2 a 5 metros (6 a 16 pés) de distância por um total cumulativo de 5 a 30 segundos sem um escurecimento automático ou capacete de soldagem com sombra 10 a 14 fornece radiação UVC/UVB suficiente para queimar a córnea. Os transeuntes que trabalham nas proximidades sem óculos de segurança de policarbonato com bloqueio de UV são frequentemente queimados pelo flash lateral refletido.
• Snow blindness (High-altitude and polar environments): Fresh snow reflects up to 80 to 85 percent of ambient UV radiation upward from the ground, while every 1,000 meters (3,280 feet) of altitude gain increases UV intensity by roughly 10 to 12 percent.
• Indoor tanning beds, shattered high-intensity discharge (HID) mercury-vapor or metal-halide lamps, and germicidal UVC sanitization bulbs: Unshielded UVC disinfection lamps cause severe bilateral photokeratitis within minutes.

Why welder's flash wakes the victim up in the middle of the night¶

Ultraviolet radiation acts photo-chemically rather than thermally. As UVB and UVC photons are absorbed by the outer squamous cells of the corneal epithelium, they induce DNA thymine dimers and cellular apoptosis. During the welding job or ski trip, the person feels completely normal. Over a 6-to-12-hour latent period, the damaged superficial epithelial cells die and slough off in thousands of pinpoint dots across the cornea (superficial punctate keratitis), exposing raw subepithelial nerve endings. Consequently, the patient typically wakes up between Midnight and 4:00 AM in severe, bilateral burning pain, feeling as though both eyes are packed with hot sand, unable to open their swollen eyelids in the light (photophobia and blepharospasm), with profuse watery tearing.

Step-by-step first aid and medical management for welder's flash¶

1. Move the person into a dark room immediately and keep both eyes gently closed: Dimming all lights and resting with both eyes shut stops pupillary constriction spasms and prevents the eyelids from rubbing over the raw punctate corneal defects.
2. Remove contact lenses immediately: Flush with sterile saline or artificial tears so lenses slide out easily without tearing more epithelium.
3. Apply a cool, damp compress over the closed eyelids: Lay a clean washcloth soaked in cool water over both closed eyes for 15 to 20 minutes at a time. Never place ice directly on the eyelids.
4. Instill preservative-free artificial tears or lubricating ophthalmic ointment frequently: Single-use preservative-free artificial tear drops or sterile lubricating night ointment applied every 1 to 2 hours coats exposed nerve endings. Do not use vasoconstrictor drops or non-sterile home remedies (such as raw potato slices, breast milk, or tea bags).
5. Seek medical care for oral analgesia, antibiotic ointment, and cycloplegic relief: A clinician will stain the corneas with fluorescein dye to rule out embedded metal sparks, and typically prescribes oral NSAIDs or acetaminophen/paracetamol, lubricating antibiotic ointment, and occasionally a single short-acting cycloplegic drop. Symptoms almost always resolve completely within 24 to 72 hours without permanent vision loss.

First aid steps protect your sight after an eye injury, but they do not replace professional medical evaluation or hands-on training. Consider taking a certified first aid course through your national Red Cross or Red Crescent society, St John Ambulance, or an occupational safety provider, and always wear ANSI Z87.1 / EN 166 wrap-around polycarbonate safety glasses when working with tools or UV light.

Perguntas frequentes¶

Fontes verificadas¶

• American Academy of Ophthalmology (AAO, United States): Preferred Practice Pattern and Clinical Guidance on Corneal Abrasion, Ocular Foreign Bodies, Open Globe Injuries, and Bacterial Keratitis.
• The College of Optometrists (United Kingdom): Clinical Management Guidelines: Corneal Abrasion, Foreign Body, Microbial Keratitis, and Photokeratitis (Arc Eye).
• National Health Service (NHS, United Kingdom) & Moorfields Eye Hospital NHS Foundation Trust: Eye Injuries, Foreign Bodies, and Welder's Flash Emergency Patient Guidance.
• Cochrane Database of Systematic Reviews (International): Patching for Corneal Abrasion (Turner & Rabiu) and Interventions for Corneal Rust Rings.
• National Institute for Occupational Safety and Health (NIOSH / CDC, United States): Eye Safety for Emergency Response and Industrial Ultraviolet Radiation (Welding Arc) Protection.
• Organização Mundial da Saúde (OMS, Internacional): Manual de Cuidados Oftalmológicos Primários: Avaliação e Tratamento de Emergência de Trauma Ocular.

Guias relacionados¶

• Eye injuries and chemical eye burns
• Queimaduras graves e descarga química
• Chili pepper and capsaicin burns in the eyes
• Head injuries and concussion signs
• Empalamento e estabilização de objetos estranhos incorporados
• Números de emergência e despacho internacional