So today I had to go to the clinic earlier than my usual time, mostly because I was woken not by my alarm but by a call from the resident nurse at my facility. It must have been quite important because I always sleep with my fon on do not disturb activated or sleep activated, even when I fail to do so manually it would do so automatically and so she must have called a whole lot for it to get through.
Waking up by the sound of my phone I quickly moved towards it because very few people in my circle have been added to the exception list and thinking these individuals are calling at this time, well it was worrying, only to realize that it was a hospital call, it made me wonder what at all could make them call me so early when in some few hours I'd still be at the clinic for work.
That was when they mentioned that an emergency has been brought in, the person is in a lot of pain and crying and holding their eye such that everyone is quite worried and confused as to what to do and so they had no other option to call me and that they apologize for disturbing my sleep. Honestly, I was quite pissed because I was like, but I'd be coming to work eventually can't it wait?
So I had to quicken my morning routine and get to the hospital as soon as possible to find out what exactly could be causing such fear and panic amongst the health workers that they were all so worked up and worried for whoever the patient may be. I eventually got there and he was ushered into my office, I had to anesthetize the eye and let him sit for a while and calm down before I could consult and manage the situation.
Patient History
To help me get a perspective of what could be going on I asked about what actually happened, now our patient is male in his early 30s and his story was that in the middle of the night, we woke up and somehow whiles looking up the ceiling something fell into his eyes, it was quite uncomfortable and so he started to rub it uncontrollably, after rubbing and realizing that the eye wasn't feeling better but rather worse he decided to try a different approach.
He now dipped his eyes in water, he kept doing this for a while and then it seem to get a bit better but then after he took his eyes out of the water it started to sting and burn again and he couldn't help but rub it some more. At this point, I was about to ask why his first impulse was to keep rubbing when the eye actually felt better when he dipped it in water but I held on so I could get the whole story.
So apparently the pain was now becoming unbearable, he realized that when he opens his eye now the light around stung and he kept on tearing profusely and he couldn't sleep again and so they had to rush him to the hospital and was why when he got to the hospital it was like that and they had to come and get me and that he is sorry but he is in a lot of pain and needs my help. So I calmed him down and assured him that we would find out what was going on and find a solution to the problem.
Examination
Looking at how injected the eye had become and his sensitivity to light I decided to stain the eye because the presentations were all pointing to something being wrong with the cornea. Anything involving the cornea could be extremely painful because the cornea is very very sensitive. It is actually one of the most sensitive organs in the entire body. So I stained and with the help of my cobalt blue light, I observed that the cornea of the eye in question had ulcerated.
Taking a critical look I now saw that the epithelium within the central part of the eye had eroded. The other eye was found and his retina was unremarkable. So I explained to him what was going on and why he is in so much pain. Then I made him understand that the rubbing action he did is what caused this and that whatever fell into the eye (which is no longer there though) must have been an insect and his vigorous rubbing caused the chemicals from the insect to erode the epithelium of the cornea
Had he just composed himself and done the water thing as the first instinct or tried to wash the eyes under running water instead of rubbing, things may have been better, even if there would have been a discomfort chances of a cornea ulcer would have been drastically down. Thankfully, the cornea epithelium doesn't take long to regrow so long as its process is not interrupted by steroids or infections. And so he had to be put on medication whiles we wait for an ulcer to heal. He was also given pain meds and then discharged satisfactorily to be reviewed in 4 days.
Conclusion
He was lucky enough to not have worsened his situation by going to buy over-the-counter medication for usage without comprehensive care which a lot of individuals tend to do in such situations. But I believe the moral of the story is quite clear and quite obvious, you may think well, it couldn't have been worse than this? But it actually could have, I was just imagining if he had ended up with an embedded object in his cornea because of his vigorous rubbing.
And so even as I conclude my story for today, I would like to admonish all of us to desist from the habit of rubbing the eye, if it has to do with allergies, cold compresses help ease the pain till you could seek professional care and if it has to do with foreign bodies or objects, do well to wash the eye under running water after which you should seek immediate care from the nearest healthcare facility. I do hope that this story enlightens a dear reader and I am grateful for your time and for reading. Have a wonderful time.
Further Reading
Hage, A., Knoeri, J., Leveziel, L., Majoulet, A., Buffault, J., Labbé, A., & Baudouin, C. (2023). Du prurit aux frottements oculaires : une revue de la littérature [From ocular itching to eye rubbing: a review of the literature]. Journal francais d'ophtalmologie, 46(2), 173–184. https://doi.org/10.1016/j.jfo.2022.09.009.
Hafezi, F., Hafezi, N. L., Pajic, B., Gilardoni, F., Randleman, J. B., Gomes, J. A. P., Kollros, L., Hillen, M., & Torres-Netto, E. A. (2020). Assessment of the mechanical forces applied during eye rubbing. BMC ophthalmology, 20(1), 301. https://doi.org/10.1186/s12886-020-01551-5.
Najmi, H., Mobarki, Y., Mania, K., Altowairqi, B., Basehi, M., Mahfouz, M. S., & Elmahdy, M. (2019). The correlation between keratoconus and eye rubbing: a review. International journal of ophthalmology, 12(11), 1775–1781. https://doi.org/10.18240/ijo.2019.11.17.
Torres-Netto, E. A., Abdshahzadeh, H., Abrishamchi, R., Hafezi, N. L., Hillen, M., Ambrósio, R., Jr, Randleman, J. B., Spoerl, E., Gatinel, D., & Hafezi, F. (2022). The Impact of Repetitive and Prolonged Eye Rubbing on Corneal Biomechanics. Journal of refractive surgery (Thorofare, N.J.: 1995), 38(9), 610–616. https://doi.org/10.3928/1081597X-20220715-03
