Eye injuries at work, and the ten seconds that prevent them

Occupational eye injury is one of the most common causes of monocular blindness in working-age Nigerians, and one of the few categories of eye disease that is almost entirely preventable with equipment that costs very little.

The recurring patterns

Flying particles. Grinding, chiselling, hammering metal, drilling concrete. A fragment travelling at speed either lodges in the corneal surface or penetrates the eye. The second is a surgical emergency, and it can be remarkably painless at first — a high-velocity fragment can enter through a small self-sealing wound, and the person carries on working.

Welding flash. Ultraviolet from an arc burns the corneal surface. It is not felt at the time. Six to twelve hours later — usually in the night — the eyes become intensely painful, streaming and light-sensitive. It heals in a day or two, but it hurts a great deal, and repeated exposure is not harmless.

Chemical splash. Cleaning agents, battery acid, cement, lye. Alkalis are worse than acids: they penetrate and continue damaging tissue for as long as they remain. Cement and lime burns from building sites are a recurring and serious presentation.

Blunt trauma. A tool, a bungee cord, a snapped cable. Damage to the internal structures — bleeding in the anterior chamber, retinal tears, lens dislocation — is often out of proportion to how the eye looks from outside.

First aid, briefly

Chemical splash: irrigate immediately. Do not go looking for a specific eye wash. Clean water, a great deal of it, for at least twenty minutes, holding the lids open. This is the single most important determinant of the outcome, and every minute of delay costs tissue. Then go to hospital, still irrigating on the way if you can.

Suspected penetrating injury: do not touch it. Do not press, do not rinse, do not attempt to remove anything protruding. Cover the eye with a rigid shield — the bottom of a paper cup taped over it works — and get to an eye casualty department. Pressure on a perforated eye can extrude its contents.

Particle on the surface: blink, and try clean water. Do not rub, and do not let anyone dig at it with a pin, a cloth or a match. If it does not come out, it needs removing under magnification, which takes a practitioner a couple of minutes.

Welding flash: it will settle. Rest the eyes, keep the room dark, and see someone if it has not improved within a day or if vision is affected.

Blunt trauma: have it examined even if it looks fine, particularly if there is any change in vision, floaters, flashes, or a difference in pupil shape.

The prevention

Impact-rated safety spectacles for grinding and machining. A proper welding shield with the correct shade for the process — and shields for anyone working nearby, because bystanders get flash burns. Chemical goggles, sealed, for handling liquids; ordinary safety spectacles do not stop a splash from below. Face shields over spectacles where the risk is significant.

Ordinary prescription spectacles are not safety equipment. The lenses are not impact-rated and the frame provides no side protection.

The obstacle is rarely cost. It is that the equipment is uncomfortable, fogs up, scratches, and the job takes ten seconds. Every ophthalmic casualty department in Lagos sees the result of that calculation several times a week.

For employers

Eye protection that is available but uncomfortable does not get worn. Protection that fits, that is kept clean, that can be worn over prescription spectacles or made to a prescription, and that is genuinely expected on site, does. Baseline vision screening for employees is also worth doing: it establishes what someone's sight was before any incident, and it finds the uncorrected errors that themselves contribute to accidents.