August can be a busy month spent squeezing in one last summer getaway, preparing for hectic school schedules to resume, and for many school nurses, enjoying the last few moments of getting some work done in a relatively quiet health office.  With everything that is going on, it is important to not lose sight (pun intended!) that it is also Children’s Eye Health and Safety Month.   A high incidence of pediatric eye trauma occurs during the school day or when children are at play and data has suggested that up to 90% of ocular injuries are preventable.  School nurses know that 80% of learning occurs through vision and advocating for and supporting eye safety through prevention measures and acute treatment of eye injuries is a critical component of promoting children’s optimal health and keeping them ready to learn.

Types + Treatment

Debris or Foreign Body–it can be common for things like dust or eyelashes to get stuck in the eye causing discomfort, irritation, and tears.  While small particles can often be flushed out with a sterile saline solution or warm (never hot!) tap water, sharp or high-speed objects that get embedded in the eye require EMS.  Never remove embedded objects or attempt to flush the eye when there is a suspected puncture, instead, dress with an eye pad, and tape a paper cup over the eye while waiting for EMS.

For dust or loose debris, flush the eye by gently pulling on the lower lid while the student tries their best to keep the top lid open and gently pour the saline or water over the eye.  It may take 1-2 hours for the discomfort and redness to subside once the particle(s) are flushed, however, if there are any vision changes or persistent tearing, blinking, or discomfort, the student should be referred for further evaluation.  Remember never to rub the eye if a foreign body or particles in the eye are suspected as this could cause a corneal abrasion.

Ecchymosis or “Black Eye”--when there is a direct blow to the eye, damage to the surrounding tissue most often causes bruising and swelling that appears 1-2 days following the injury.  Most black eyes are not accompanied by any damage to the eye itself and with some TLC, heal completely.  Place a cold pack (do not apply pressure) on the eye for 20 minutes and repeat every few hours for the first 24-48 hours.  After 48 hours, switch to warm compresses which will help reabsorb the blood.  Keeping the student’s head elevated at night can further reduce swelling and promote healing.  Further evaluation is necessary if there are vision changes, concussion symptoms are present, or if the pain is severe.

Subconjunctival Hemorrhage–this can occur when the tiny vessels covering the sclera (white part of the eye) break and leak blood.  This is a mild injury that is often caused by sneezing, coughing, vomiting, or any type of straining.  It is a mild, painless injury that on its own, with no vision changes or other concerning symptoms, does not require medical care and typically resolves within 1-3 weeks.

Chemical in the Eye–for chemical burns, EMS should be activated and immediate irrigation of the eye with saline, eye wash, or water is critical, using caution to avoid chemical spilling or splashing into the other eye.  The appropriate Safety Data Sheet should be provided to the EMS providers.  

 Prevention

Prevention measures to reduce eye injuries in the school setting can make a major impact on children’s eye health and safety.   School nurses can play a key role by:

• Advocating for protective eyewear for sports or activities requiring a ball or racket or involving physical contact with other players.
• Providing education on safe handling of chemicals, requiring the use of protective eyewear in labs, and ensuring available eye wash stations where appropriate.
• Promoting safe use of common objects that are known eye injury hazards including paper clips, rubber bands, pencils, pens, and scissors.

For any injury to the eye, the main concern is whether the vision is affected.  In children, it can be difficult to assess self-reported vision changes and it is recommended to err on the side of caution to safely determine if there is vision damage.  When school nurses “keep an eye” on school eye safety, they help keep their students' eyes open to learning and focused ahead on a bright and healthy future.