What Should I Do If Something Gets in My Eye?

That sudden scratchy, watery, can't-open-my-eye feeling when something blows in is alarming, and the instinct is to rub, which makes it worse. People want the safe way to get it out and, just as important, how to tell an ordinary speck from something that could actually damage the eye.

Most of the time a foreign object lands on the surface of the eye or the inside of the eyelid, not inside it. The cornea, the clear dome over the colored part, is packed with nerve endings, which is why a tiny particle feels enormous and makes the eye tear and clamp shut. Tears and blinking are designed to wash surface debris toward the corner of the eye where it can be rinsed away.

The concern is when an object scratches the cornea (a corneal abrasion) or, far more seriously, when a fast-moving fragment pierces the eye wall. A scratch is painful but usually heals; a penetrating injury is an emergency because it can let infection in and permanently harm vision.

Common surface foreign bodies are dust, sand, sawdust, an eyelash, or bits of makeup. These sit on the conjunctiva or cornea, or hide in the groove under the upper eyelid, scraping the cornea with every blink until they are removed. Flushing with clean water or sterile saline, and sometimes sweeping under the lid, clears most of them.

High-velocity particles are a separate category. Metal thrown off a grinding wheel, a chip from hammering metal on metal, glass, or debris from a lawnmower can travel fast enough to penetrate the eye and lodge inside. This may cause surprisingly little pain at first, which is exactly why it is dangerous. When the history involves those activities, imaging is needed to rule out an intraocular foreign body, and metal left inside can slowly poison the retina over time.

Treat it as urgent and seek care the same day, or go to an emergency room, if you have any of the following:

• The object hit your eye at speed while grinding, hammering, drilling, or mowing.
• You see a cut or a teardrop-shaped pupil, or fluid or jelly leaking from the eye.
• Pain, light sensitivity, or blurred vision that does not settle after rinsing.
• You cannot remove the object, or it feels embedded.
• Redness, watering, or a foreign-body sensation lasting more than a day.

The doctor first asks what you were doing and what the object likely was, since that predicts how dangerous it is. Vision is checked, then the eye is examined under the slit-lamp, a bright microscope, often after a drop of fluorescein dye that glows under blue light and reveals corneal scratches. The upper lid is flipped to look for a trapped particle. If a high-speed metal or glass fragment is possible, a CT scan of the orbit is ordered to look for a fragment inside the eye; MRI is avoided when metal is suspected.

A loose surface particle is irrigated out or lifted off at the slit-lamp. A corneal abrasion is treated with antibiotic drops or ointment to prevent infection while it heals over a few days, with lubrication for comfort. A rust ring left by a metal fleck is gently removed. A foreign body that has penetrated the eye is a surgical emergency: the eye is shielded, tetanus status is checked, antibiotics are started, and the fragment is removed in the operating room. Do not treat a penetrating injury with drops or pressure yourself.

• Do not rub the eye; it scratches the cornea and can push a fragment deeper.
• Do not try to remove anything that is stuck, embedded, or on the cornea itself.
• Do not use tweezers, cotton swabs, or a fingernail to dig at the eye.
• Do not press on or patch a penetrating injury; protect it with a rigid shield and get to an ER.
• Do not put a contact lens back in until the eye is fully comfortable, and do not ignore lingering pain.

If you flushed the eye and it feels normal, you can watch it. Call May Eye Care Center for a same-day visit if there is lasting pain, light sensitivity, blurred vision, or a feeling that something is still there, and go straight to an emergency room if a high-speed metal or glass fragment may have struck your eye or you see a cut or leaking fluid. Patients across the Hanover area can reach the office quickly for an urgent look.

Flush, don't rub: most specks rinse right out. But a high-speed fragment, a stuck object, or pain and blurred vision that won't quit needs prompt eye care, not watchful waiting.