POW! SLAM! THWACK! THUD! and OOOF! when accompanied by lots of breaking furniture—of course—usually leaves the comic book hero with nothing worse than a black eye that can be quickly cured by putting a raw steak over it. The damage can't even be noticed in the next scene.

Pity it isn't that simple in real life.

Let's look at the reality of the situation.

Although the eyes are set back relatively deeply in the skull and are protected by the cheekbones, the nose, and the ridge of bone underneath the eyebrows—as well as the eyelids—they can and do come in fairly frequent contact with flying squash balls, Frisbees, and fists. Not to mention coat hangers, doors, a baby's fingers, champagne corks, firecrackers, broken glass, and a list of other objects long and varied enough to make reading a hospital emergency room's "cause of accident" survey interesting, informative, and at times tragically sad or embarrassingly funny.

The eyeball itself is a rather tough and resilient organ. If the injury is mild, the eye heals rapidly. If, however, the damage is severe, it can lead to blindness.

Let's consider some of the more common causes of eye injuries, how they are treated, and—more important—how they might be prevented.

Most types of eye injury have been around for as long as there have been eyes. After all, it doesn't make much difference to the eye whether it is hit with a state-of-the-art, computer-controlled plastic Frisbee or with A caveman's club. The reaction is still the same: Ouch! Other types of injury and potential injury are uniquely a product of our technology, though. Our ancestors didn't have to worry, for example, about welding torches or sunlamps.

Regardless of the type of injury or how modern its cause, there will be times when you aren't sure if you should immediately seek medical assistance or not. Each case is different, but as a general rule, when in doubt, see your doctor. And never adopt a "wait-and-see" attitude, because if you wait too long you just might never see again.

While we cannot tell you when you do not need to seek medical attention, we can tell you when you should. If any one of these conditions is present as the result of an injury, see your doctor.

• Pain and redness
• Pain plus a discharge from the eyes
• Blurred or double vision
• Any loss of vision
• A layer of blood between the cornea and the iris
• An eye that does not move as freely and completely as the other eye
• When one eye is protruding farther forward than the other
• When one pupil's size or shape is abnormal compared to the other eye
• A cut or penetration of either the eyelid or eyeball
• Spots, streaks, "flashing lights," or anything else that nterferes with or obscures your vision, whether or not they are accompanied by pain.

Can VDTs Injure the Eyes?

There has been no proof that video display terminals (VDTs) emit enough of any sort of radiation to injure anyone's eyes. But VDT users do have legitimate complaints. The most frequent ones are eye fatigue, eye irritation, and blurred vision. Next come the complaints of tired, itching, burning, or watering eyes; headaches; flickering sensations; and double vision.

VDT users also complain about back, neck, or shoulder pain or stiffness. This is usually a result of poor posture or sitting at a desk that wasn't designed for computer work.

Poor design is also a problem in terms of lighting. Too much light can "wash out" a screen or cause glare. This can lead to eyestrain, as can working without enough light.

If you already wear glasses, you might want to have a "VDT tint" added to your lenses. This is a light tint that blocks out about 20 percent of the light. An antiglare coating can also help.

When it comes to actual eye problems, the main one is eye fatigue. The human eye was not built to focus on one small screen for hours at a time. That's why one of the best "cures" for VDT-related eye problems is a 15-minute break from looking at the screen every hour.

Sometimes, reading or magnifying glasses can be used to put your VDT screen in perfect focus. This way the glasses do the focusing instead of your eyes. This is especially helpful for people over 40.

Most reading glasses are designed to put things in sharp focus at the normal reading distance-16 inches. VDT screens are usually 21 inches from the eyes. Therefore, a slightly different reading prescription—usually a weaker one—will be needed for computer work.

The human eye is "at rest" when looking off into the distance. That's why staring out the window is so relaxing. It's not only the view that's good for you, but the fact that the eye doesn't have to work at focusing on anything up close.

A Black Eye

Despite what you see on TV or in the movies, and no matter how many funny stories or cartoons you've seen, a black eye is no joke, no matter what the cause of the injury—a flying fist, a swinging door, a pointing finger, or a popping champagne cork.

The dark color and swelling that surround the injured orb are caused by damaged blood vessels and bleeding under the skin.

At times there can even be bleeding within the eye itself that leads to a hyphema, a buildup of blood behind the cornea. If that bleeding continues, the anterior chamber of the eye can fill with blood. Pressure may build up and damage the optic nerve. If the blood is not absorbed, it may have to be "washed out" by a surgical operation. In effect, a "simple" black eye can turn into a form of glaucoma that is extremely difficult to treat.

Every year countless men, women, and children suffer major eye damage—and blindness—due to "simple" black eyes.

If you do get a black eye, and if you also just happen to have the "traditional" raw steak handy, you'd be better off barbecuing the steak as a treat for yourself—after you've used an ice pack on your eye.

How did the idea of placing a raw steak over a black eye as a "cure" get started? No one really knows for sure, but it could be because raw meat, when properly stored in a refrigerator, is cold. It's the cold that can reduce the swelling, not the meat. Also, a steak is floppy, so it will conform to fit the face. But there are problems with this age-old remedy, problems such as the high cost of steak (especially when compared to the cost of ice cubes); bacteria on the steak, which could infect the eye; and the general yuckiness of covering your face with red, raw, and bleeding meat.

Stick with an ice pack.

The ice pack should be applied gently around the eye for about 15 minutes. Repeat this every hour as needed. But do not put pressure on the eye itself. The coldness will constrict the blood vessels of the eyelids and reduce bleeding and swelling. You should also have a doctor look at your eye, especially if you experience any change in your normal vision such as blurriness or double images.

Beware Those Popping Corks

For those who consider champagne and other sparkling wines to be synonymous with festive occasions, the pop of the champagne cork is an important part of the ritual that makes imbibing the bubbly stuff so much fun.

If you're not careful how you open the bottle, however, you can get bleary-eyed—and bloody eyed—even before you drink the first drop.

That's because popping champagne corks are a lot like the BB guns your mother always warned you about when you were a kid. They can put your eye out.

There are seven things to remember about opening a bottle of champagne.

1. Keep the bottle chilled. A warm bottle is more likely to blow its cool—and its cork—than a properly chilled bottle.
2. Don't shake the bottle!
3. Before opening, peel the foil off the cork, and then hold the cork in place with your hand while you peel back the wire hood.
4. Place a towel over the bottle top and cork.
5. Twist the cork to break the seal. If the cork is stuck, run cool tap water over it for about 30 seconds or so and try again.
6. Make sure the cork is not aimed at anyone or at anything breakable.
7. Slowly twist and pull the cork out of the bottle.

Even though this method produces a more muted "pop" when the bottle is opened, it does retain more of the carbonation and will keep the bubbly bubblier longer.

Lacerations

Knife wounds, gunshot wounds, and explosions can do serious and permanent damage to both you and your eyes.

If the eyeball is perforated, aqueous humor leaks out. The front part of the eye can collapse in much the same way that a bean bag collapses when some of the beans leak out. And that's only part of the problem. The same rip, tear, or hole that lets the aqueous humor out can also let infection in. Bacteria entering the eye can cause endophthalmitis, a potentially blinding infection.

A perforated eye is a medical emergency. Do not attempt to wash or irrigate the eye. If the object that perforated the eye is still stuck there, leave it for a doctor to deal with. Pulling it out could cause the loss of more fluid and lead to more damage.

The eye should be covered at once with a loosely fitting patch or metal shield. Then the patient must be rushed to a doctor—or emergency room—immediately so that the laceration can be sewn up and the pressure within the eye restored.

The alternatives to immediate medical treatment are glaucoma, infection, and blindness.

Foreign Bodies in the Eye

Small particles can enter the eye on a windy day, or while you're driving with the window open, riding a bike, or jogging down the lane. A foreign body is usually quickly washed out of the eye by a flood of tears and the windshield-washer action of the eyelids. The wiper effect forces the particle off to the side of the eye and onto the eyelash or the eyelid.

It is the sharp-edged particle that can cause serious problems. Bits of metal, wood splinters, or chips of paint or stone can become lodged in the cornea or under the upper lid, producing a painful and persistent irritation. This type of injury is common among mechanics, construction workers, and tooland-dye or lathe operators.

If something like this should happen to you, remember what your mother told you: "Don't rub it!" The first thing to do is blink. That might be enough to dislodge the speck.

If blinking doesn't work, lift the upper lid over the lower lid and blink a few more times. This lets the eyelashes of the lower lid brush the inside of the upper lid, possibly discharging any speck that is stuck there. If that doesn't work, keep the eye closed until you can get help.

It is often impossible for people to remove these particles themselves, no matter how long they spend irrigating or flushing out the eye. If a friend or a coworker can help, let them. If not, get to a doctor—fast.

Although these injuries are common and can be extremely painful, the treatment is relatively simple, and infections or other complications are few. Once the particle is removed, the eye usually heals in just a few days with the help of dilating drops and antibiotics.

Although treatment for this type of injury is simple, the very best policy is prevention. If your job or hobby puts your eyes in this type of danger, wear protective, industrial-strength eyeglasses or eye guards.

If you already wear glasses, you can get safety lenses ground to your prescription or nonprescription eye guards that will fit over your glasses. If you're out jogging or bicycling in sandy areas during the day, wear sunglasses. They can protect your eyes from more than just sunshine.

If you have only one good eye, you might want to wear some sort of eye protection all the time, no matter what you are doing, and choose your sports or other activities with extreme care.

Ultraviolet Burns

We've already discussed the dangers of UV light and the damage it can do to the cornea in the section on sunglasses. But the sun is not the only UV source.

Sunlamps and tanning beds also produce UV light. So do arc welding torches and some lasers. If you must use a sunlamp, a laser, a tanning bed, or a welding torch, make sure your eyes are protected.

A UV burn can cause an abnormal sensitivity to light, blurred vision or blindness, a sandy sensation in the eyes, and pain—lots of pain.

How to Tan without Burning Your Eyes

A tanning bed or sunlamp can give your entire body a pleasant glowing tan or a nasty and painful glowing bum—and your eyes are two of the first parts of the body that can be burned.

Unless you want to join the thousands of people who have learned just how painful and lasting "sunburned eyes" can be, there are three simple rules to follow.

1. Always wear the special goggles provided or recommended by the sunlamp's or tanning bed's manufacturer. If they are not available, use other goggles (not glasses, goggles!) which fit snugly around the eyes and block out potentially blinding UV radiation. Never use sunglasses or cotton balls as substitutes. They do not adequately protect the eyes.
2. Staying under a sunlamp or tanning bed longer than the manufacturer's recommendation will not give you a faster tan. It will give you a fast burn.
3. If you experience any of the eye burn symptoms—redness, light sensitivity, blurry vision, or pain—stop tanning immediately and see your eye doctor.

Follow these rules regardless of which type of tanning device you use. Sunlamps are usually labeled as producing either UVA or UVB radiation. Natural sunlight contains both types. Even though UVA sunlamps are the most popular because they screen out more of the UVB (often referred to as the "burning" radiation), both types can be dangerous if not used properly.

If you're having problems under the sunlamp or tanning bed even while following all the rules, your diet—or your medication or cosmetics—might be causing the trouble. Certain chemicals can make eyes more sensitive to UV radiation. Some of the more common photosensitizing chemicals are found in celery, citrus fruits, birth control pills, antibiotics, high blood pressure medication, antihistamines, and in some cosmetics. So if you are having problems, you might want to talk to your pharmacist or doctor.

Fortunately, a UV burn rarely leads to permanent blindness. With the aid of dilating eyedrops and a tight eye patch, the cornea usually heals in a few days. The eyedrops are used to relax the muscles of the iris and ciliary body. The tight eye patch is to prevent painful blinking, which can slow down the healing process.

Chemical Burns

We're all familiar with the dangers of hazardous industrial chemicals, and we usually assume that those dangerous chemicals are in factories far away from us and our children.

Wrong! Often the main differences between a hazardous industrial chemical and a helpful household cleaner is the size of the container or the name that's on the label.

You have to wonder, for example, why the word chlorine conjures up such horrifying images when it's talked about in terms of leaking out of a crashed railroad car, and yet it produces such pleasant and sweet-smelling images when talked about in terms of "New and Improved Super Duper Sudso Cleano with Chlorine Added!"

Chlorine is just one of the chemicals that can be found in many household cleaners and solvents. Many of these chemicals can burn the eye's delicate tissues after only a few seconds of exposure. Acids and alkalis are among the most dangerous. Acids usually cause extremely painful burns to the surface of the eye. Alkalis, such as ammonia, can penetrate the eye in a matter of seconds and destroy vision.

It is important that tight-fitting goggles be worn whenever you handle any dangerous chemicals. If a chemical does get in your eye, act fast. You have to irrigate the eye immediately.

One simple treatment is to simply stick your face—with your injured eye open—in a sink full of clean water and swish the water around. An even better treatment is to stick your eye under running water: a faucet, a drinking fountain, or an eye wash fountain. Use your fingers to keep the eye open, and roll your eyeball as much as possible to wash the chemical out.

The eye should be washed for at least 15 minutes for acid burns and at least 30 minutes for alkali burns. In the case of any chemical burn, the eye should also be examined by a doctor after the irrigation has been completed.

Eric Rost

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