When Regular Eye Protection Isn’t Enough: Yard Work Injury Threatens Vision

By Reena Mukamal, Contributing Writer for the American Academy of Ophthalmology – originally published at www.aao.org.

If you think the only people who suffer vision-threatening eye injuries from yard work are those who fail to wear proper eye protection, ophthalmologist Sanjiv Dr. Kumar, MD, has some news you. Dr. Kumar was wearing the right eye protection when he set to work on a thicket of branches on a hot August morning earlier this year, but he still suffered an eye injury that almost cost him his sight.

At first, he thought he escaped disaster, the damage seemed minimal. But a few hours later it became obvious that he needed to be seen by an ophthalmologist — and quick. While his eye protection failed him, his knowledge of eye injuries, and the expert care of his ophthalmologist, saved his vision.

It’s a reminder that certain types of eye protection are safer than others. And any injury to the eye, even one that seems minor at the time, should be checked out by an ophthalmologist.

Not All Forms of Eye Protection Are Equal

Dr. Kumar is a Texas-based ophthalmologist, a medical doctor specialized in eyes and vision. In his spare time, he enjoys real estate entrepreneurship and property renovation. That’s what he was doing one hot August morning on his day off. Dr. Kumar had rolled up his sleeves to clear out an area of thorny overgrowth in the backyard of a new home he was remodeling.

As an eye doctor, Dr. Kumar is “crazy about having eye protection” and keeps a small arsenal of protective eyewear with him at all times. He put on polycarbonate, ANSI-approved safety glasses (made to meet safety standards of the American National Standards Institute) before he got to work. When he kicked at a broken branch, it snapped and fell toward him, dragging two other branches with it.

“One branch knocked off my glasses and another brushed right past me,” he said. Dr. Kumar immediately felt around his face, pulled out and examined his contact lens, and checked his reflection on the phone camera. “Everything looked fine—no scratches on my face, no tear in the contact,” he said. Relieved, he thought to himself “that could have been bad,” and went about his day.

But several hours later he started to feel that something wasn’t right. He was noticing “a slight fog” in the vision of his right eye. Because he had a long drive ahead of him that evening and back-to-back patients in clinic the next day, he decided to get his eye checked just in case. He found an ophthalmologist nearby and they chatted as the doctor examined him. “Suddenly he got very quiet,” Dr. Kumar recalled. “Then he told me I had a ruptured globe,” said Dr. Kumar. “I was shocked.” He was referred to retina specialist John Fitzpatrick, MD.

An Open Globe Is a Medical Emergency

A ruptured globe (also called “open globe”) occurs when something enters the eye or hits it with blunt force. Approximately 200,000 open globe injuries are diagnosed each year around the world, most often in men and boys. They are typically caused by a fight, fall, firearm, workplace injury, or car accident. “Yard work is another common source of open globe injury,” said Dr. Fitzpatrick, when tree branches or other debris hit the eye. An open globe can cause serious, lasting vision loss if not immediately treated by an ophthalmologist. 

The eye requires a certain amount of pressure inside, explained Dr. Fitzpatrick. If a hole is poked in the eye, the contents begin to move from the high-pressure area inside the eye to the low-pressure area outside, which can immediately endanger vision.

“The outcome can be catastrophic if the insides of your eye come out,” said Dr. Fitzpatrick, who has treated numerous open globe injuries. “The prognosis varies depending on what eye structures are affected and the amount of time that passes,” he explained. “Another pressing concern is the possibility of infection from bacteria that enters the eye,” he added. 

Dr. Kumar’s wound was in the very front of the eye. Most open globe injuries harm parts deep inside the eye, such as the retina or lens. Sometimes they reach all the way back to the optic nerve, explained Dr. Fitzpatrick.

A ‘Minor’ Eye Injury May Be More Serious Than You Realize

Likely, a small piece of falling tree branch penetrated Dr. Kumar’s cornea. The puncture, like a small prick in a water balloon, caused the eye to de-pressurize. As the fluid inside began to move, Dr. Kumar’s iris — the color part of the eye behind the cornea — was sucked up into the wound. “Dr. Kumar’s iris effectively plugged the wound like a cork and stopped it from actively leaking, which is probably why he didn’t notice any symptoms until later,” explained Dr. Fitzpatrick. As time went on, Dr. Kumar began to develop inflammation inside the eye — a natural healing response of the body — which is likely what caused his vision to become cloudy, said Dr. Fitzpatrick. 

Fast Treatment of Eye Injuries Can Save Vision

An open globe repair requires surgery under general anesthesia. Dr. Kumar was in the operating room by 9 p.m. that same evening. Dr. Fitzpatrick pulled Dr. Kumar’s iris out of the wound, put it back into place, and closed the wound. To kill any bacteria or fungus, he injected antibiotics and anti-fungal medication directly into the eye. “We take this extra measure if vegetation gets inside the eye,”  he explained.

Dr. Kumar went home later that evening with a shield and patch to protect his eye as it healed, a course of antibiotics and steroid eye drops to reduce inflammation. He was back in his own clinic seeing patients just two days later. 

Wraparound Eye Protection Saves Vision

“Dr. Kumar was very lucky on multiple counts,” said Dr. Fitzpatrick. He was wearing wrap-around protection that likely shielded his eye from an even more severe injury. And he didn’t wait it out after noticing a change in his vision; he sought out an ophthalmologist right away. One month after his surgery, Dr. Fitzpatrick removed the sutures and measured Dr. Kumar’s vision at 20/20. “Everything looks healed,” he said.

Dr. Kumar said the experience was a personal wake-up call that you can never be too careful when it comes to your eyes. Although he was wearing appropriate protection, next time he will use even more secure safety glasses — with a strap attached to help keep them in place — he said. 

“You should wear eye protection that is shatter resistant and wraps around the side of your eye whenever you’re doing any type of work or hobby with even a remote chance of anything hitting you in eye,” said Dr. Fitzpatrick.

Equally important in case of an eye injury or any noticeable change in vision, no matter how slight, is to get medical care immediately. If you think it’s possible that you have an open globe, it’s important that you don’t rub or apply any pressure to the eye and that you go straight to the ophthalmologist or ER.

“The biggest tragedies we see in eye medicine often come after a delay in seeking out a doctor,” said Dr. Fitzpatrick.

“I could have waited, but pushing myself to get my eye checked out was the right move,” said Dr. Kumar.