Ocular trauma continues to be the primary cause of avoidable monocular or bilateral blindness around the world despite significant improvements in both the avoidance and management of trauma to the eye [1]. Preventing eye injuries and severe risks or complications is a must, as well as knowledge, attitude, and practice towards eye injury first aid. In addition to injury avoidance techniques, eye injuries' characteristics must be recognizable. According to the World Health Organization (WHO), around 55 million people have damage to the eyes worldwide every year, resulting in 750,000 admissions to hospitals, over 23 million people suffering from severe visual consequences, and nearly 55 million ocular injuries [2]. In the Kingdom of Saudi Arabia (KSA), a study was done in King Abdulaziz University Hospital (KAUH) in Riyadh, Kingdom of Saudi Arabia, in July 2010 to investigate the number and characteristics of patients coming to the Emergency room complaining of ocular emergency which reveals that more than 50% of those patients did not have an actual ocular emergency [3]. Moreover, in the United States (US), approximately 2.4 million annual US emergency department visits are related to ocular injuries [4].   Ocular emergencies such as corneal epithelial defects, chemical burns, chalazion, conjunctivitis, retinal detachment, glaucoma, and uveitis are common ocular emergencies encountered in Saudi Arabia. Previous epidemiological studies worldwide have identified the characteristics and mechanisms of injury associated with different eye emergencies. In KSA, trauma was the most common reason for ER visits (61%), followed by conjunctivitis (14.9%) [3]. This is similar to the US, where trauma was also the first reason for ocular emergency visits [4]. Corneal epithelial defect (CED) is defined as the loss of the superficial epithelial layer of the cornea and is considered a medical emergency. The majority of CED cases happen due to mechanical trauma [3]. However, the major cause of the young population is fingernail trauma [3]. These injuries can present with tearing, pain, photophobia, foreign body sensation, and a gritty feeling [4]. Locally, a retrospective study was conducted at King Abdulaziz University Hospital (KAUH) in Riyadh, Kingdom of Saudi Arabia, in July 2010, involving a total of 1,412 patients. The incidence of corneal abrasion was 277 (72.5%) [5].   Chemical burns are another form of eye injury; they happen when a chemical, power, or fluid comes in contact with the cornea or conjunctiva of the eye. Symptoms can vary from temporary tearing, blurred vision, to total visual loss or loss of the globe if there is no medical intervention [6]. Most chemical ocular burns are preventable by increasing the Saudi population's awareness of prompt water irrigation and first aid [7], considered secondary prevention. However, the primary prevention is encouraging employees in high-risk occupations to wear eye protection glasses (protective goggles) [8]. Chalazion is a benign inflammatory lesion of the sebaceous glands of the eyelids. The superficial chalazion is caused by inflammation of a Zeiss gland. However, deep chalazion is caused by inflammation of the tarsal meibomian gland [9]. A retrospective study used the medical records of patients attending the A/E at King Abdulaziz University Hospital (KAUH) in Riyadh, Saudi Arabia. 77.5% of the cases were self-referrals. Additionally, 50.4% were considered non-emergency, and patients visited for dry eye, allergy, blepharitis, and chalazion [5]. Conservative management is the initial management for chalazion, which mostly resolves within a month [10]. Contact lenses positioned on the eyes have beneficial purposes in correcting vision. CL has also become widely used for cosmetic purposes. In the United States, around 40.9 million adults wear CL, and 99% do at least one hygiene-related risky behavior [11]. A local study in Jeddah, 66% was the average compliance rate to CL care. In addition, low levels of participants reported washing their hands before CL use. Interestingly, researchers found that participants overuse CL because of believe there is no harm was the reason for overusing them [12]. Regarding conjunctivitis, it refers to any inflammatory condition of the membrane that lines the eyelids and covers the exposed surface of the sclera [13]. The prevalence and incidence of conjunctivitis are alternatively based on etiology. It is either infectious, like viral, bacterial, fungal, and parasitic, or non-infectious like allergic conjunctivitis [14]. A study in Aseer, Saudi Arabia, found that 51.2% of participants view eye inflammation as harmless and believe itching is the main allergy symptom. Furthermore, 58.7% do not believe it is contagious. These findings suggest low awareness among university students [15].   Retinal detachment refers to the separation of the retina from the underlying retinal pigment epithelium and choroid [16]. Having knowledge about the disease is essential in order to have positive outcomes and to save the sight of affected patients. According to a recent study conducted among 1076 adults in Poland, approximately 40% of the participants were aware of retinal detachment and had good outcome knowledge [17]. Glaucoma refers to a pathology of the optic nerve caused by degeneration of ganglion cells of the retina, which will lead to optic disc cupping and hence vision loss [18]. Worldwide, glaucoma affects around 70 million people [19]. In Saudi Arabia, there are different epidemiological data about glaucoma. A community-based survey targeting those aged 40 years and older who lived in Riyadh found that glaucoma affected more than 1/20 Saudis who were aged 40 years and older [20]. Regarding uveitis, an inflammation of the uveal part of ocular tissue, which contains the iris, ciliary body, and choroid [21]. Among the working-age population, uveitis is one of the major causes of legal blindness [22]. In Saudi Arabia, the largest study investigated the types of uveitis in a tertiary care center in the Riyadh region, found that among a total of 888 uveitis patients, 43,9% were men with a mean age of 39 years old. Uveitis was binocular in 63% of cases [23]. Uveitis is a sight-threatening condition; therefore, inadequate knowledge about the sequelae of untreated uveitis would delay the detection of uveitis before vision loss is clinically apparent.   Understanding the Saudi general population's knowledge, attitude, and practice regarding eye injuries would prevent secondary vision-threatening complications, improve outcomes, and avoid unnecessary emergency visits.   Objective of Study   To assess knowledge of the general population in Saudi Arabia regarding eye injury first aid and common ocular conditions To evaluate public attitudes towards eye injury prevention and management To examine practices adopted by the population in response to eye injuries To determine associations between demographic factors and KAP levels To identify specific knowledge gaps that require public health education

A descriptive cross-sectional web-based study was conducted to assess public knowledge and awareness about eye injuries in Saudi Arabia. A total of 196 eligible participants completed the study questionnaire. All persons aged 18 years or above who consented to participate in the study and live in Saudi Arabia were enrolled in the study’s final analysis. Persons who declined to consent, were aged below 18 years, or spoke a language other than Arabic and outside Saudi Arabia were excluded from the study. An online questionnaire was developed by the study researchers after a literature review and consulting the field experts. Questionnaire validity, reliability, and clearness were evaluated by 3 expert staff independently with all changes done till achieving the used version of the study questionnaire. Reliability co-efficient bases on a pilot of 10 persons was assessed as 0.71. The anonymous questionnaire was published using the social media platforms from April, 2024 to June, 2024. Respondents were encouraged to participate in this study by clarifying the extent of confidentiality of participation and the importance of this research to society's health. The questionnaire of this study included participants' demographic data (Age, Gender, Residence, Education, Occupation, Monthly Household Income, Marital Status, eye injury history). The second part covered participants' knowledge and awareness about eye diseases and injuries, trauma, and first aids with single of multiple correct answers allowed. The final questionnaire was uploaded till no more new answers were obtained.   Inclusion and Exclusion Criteria Residents of Saudi Arabia who were able to comprehend, read, and write Arabic or English were included in the study. Participants with incomplete answers to questions and who were outside Saudi Arabia were excluded from the study.   Persons who declined to consent, were aged below 18 years, or spoke a language other than Arabic and outside Saudi Arabia were excluded from the study.   Data analysis The data were collected, reviewed, and then fed to Statistical Package for Social Sciences version 21 (SPSS: An IBM Company). All statistical methods used were two-tailed with an alpha level of 0.05, considering significance if the P value is less than or equal to 0.05. Overall knowledge and awareness levels regarding eye diseases and injuries were assessed by summing up discrete scores for different correct knowledge items. The total knowledge score for each disease or injury was calculated, and the overall knowledge score was categorized as a poor level if the participant's score was less than 60% of the overall score, and a good level of knowledge was considered if the participant's score was 60% or more of the overall score. Descriptive analysis was done by prescribing frequency distribution and percentage for study variables, including participants' personal data and income. Also, knowledge regarding eye diseases and injuries was tabulated while overall knowledge was graphed. The mean and percentage scores of totals were calculated for each disease and injury. Cross tabulation for showing factors associated with study participants' knowledge of eye disease and injury was carried out with Pearson chi-square test for significance and exact probability test if there were small frequency distributions.

A total of 196 eligible participants completed the study questionnaire. Participants' ages ranged from 16 to 70 years, with a mean age of 34.4±12.8 years old. A total of 116 (59.2%) were female participants, and 190 (96.9%) were Saudi. 109 (55.6%) were single, 143 (73%) had university degrees, and 18 (9.2%) had postgraduate degrees. Monthly income less than 5000 SR was reported among 24 (12.2%), 5000-10000 SR among 39 (19.9%), 10000-20000 Sr among 50 (42.3%), and 83 (21.4%) had more income (Table 1).   Table 1: Personal Characteristics of Study Participants, Saudi Arabia Personal data No % Age in years 16-24 78 39.8% 25-34 42 21.4% 35-44 34 17.3% 45-54 31 15.8% 55-64 11 5.6% Gender Male 80 40.8% Female 116 59.2% Nationality Saudi 190 96.9% Non-Saudi 6 3.1% Marital status Single 109 55.6% Married 87 44.4% Educational level Secondary / below 35 17.9% University degree 143 73.0% Post-graduate 18 9.2% Monthly income < 5000 SR 24 12.2% 5000-10000 SR 39 19.9% 10000-20000 SR 50 25.5% 20000-40000 SR 42 21.4% > 40000 SR 41 20.9%     Table 2 participants' knowledge and awareness about eye diseases, injuries, and first aid. As for glaucoma, 33.2% correctly defined glaucoma, 76.4% reported loss of vision as a symptom, followed by Eye pain and redness (39%), and Headache and vomiting (25.1%). Regarding the first thing you will do if you think you have glaucoma, 78.5% know about going immediately to the emergency department, and 85.2% know that Regular follow-up with an ophthalmologist is the best practice a glaucoma patient should take. Considering uveitis, 54.1% correctly defined uveitis, 67.3% correctly reported Eye pain and redness as a symptom, and 35.2% for loss of vision, but 18.9% knew about Headache and vomiting. Approximately 70.8% know that they should go immediately to the emergency department/ PHC when they have uveitis, and 68.7% said that using anti-inflammatory eye drops that have been prescribed by a doctor is the best practice.   Table 2. Participants' knowledge and awareness about eye diseases, injuries, and first aid. As for glaucoma, 33.2% correctly defined glaucoma, 76.4% reported loss of vision as a symptom. Uveitis, 54.1% correctly defined uveitis, 67.3% correctly reported Eye pain and redness as a symptom, and 35.2% for loss of vision.   Table 2: Participants' Knowledge and Awareness About Glaucoma and Uveitis Eye diseases and injuries knowledge No % Glaucoma What is glaucoma? Condition in which it damages the optic nerve and is usually associated with increased intraocular pressure. 65 33.2% Condition in which the lens of the eye becomes cloudy 101 51.5% Inflammation of the outer layer of the eyes 17 8.7% Condition in which a thin layer of tissue (the retina) at the back of the eye pulls away from its normal position 13 6.6% Symptoms of glaucoma Eye pain and redness 76 39.0% Headache and vomiting 49 25.1% Loss of vision 149 76.4% Itchiness 47 24.1% Eye dryness 67 34.4% What is the 1st thing you will do if you think you have glaucoma? Go immediately to the emergency department 153 78.5% Use of over counter lubricants eye drops 27 13.8% Wash your eye with lukewarm water 9 4.6% Cover your eye with patch 6 3.1% Which of the following is the best practice that should be taken by a glaucoma patient? Regular follow up with an ophthalmologist 167 85.2% Use alternative medicine methods such as Cautery/ honey 11 5.6% Regular use of anti-inflammatory eye drops 18 9.2% Uveitis What is uveitis? Inflammation of the middle layer of the eyes 106 54.1% Condition in which a thin layer of tissue (the retina) at the back of the eye pulls away from its normal position. 35 17.9% Condition in which it damages the optic nerve and is usually associated with increased intraocular pressure. 27 13.8% Condition in which the lens of the eye becomes cloudy 28 14.3% Symptoms of Uveitis Eye pain and redness 132 67.3% Headache and vomiting 37 18.9% Loss of vision 69 35.2% Itchiness 99 50.5% Eye dryness 78 39.8% What is the 1st thing you will do if you think you have Uveitis? Go immediately to the emergency department/ PHC. 138 70.8% Use of over counter lubricants eye drops 26 13.3% Wash your eye with lukewarm water 19 9.7% Cover your eye with patch 12 6.2% Which of the following is the best practice that should be taken by a Uveitis patient? Use of anti-inflammatory eye drops that have been prescribed by a doctor. 134 68.7% Putting teabags on the eyes 11 5.6% Not to do anything as it is a self-limited condition 15 7.7% Regular use of lubricant eye drops 35 17.9%   With regard to conjunctivitis, 46.2% correctly defined the disease, 58.7% know about Eye Itchiness and discharges as a symptom A total of 71.8% know about going to the ophthalmologist the first thing. Regarding Retinal detachment, 65.3% correctly defined the condition, and 73% know that Visual field defects are the main symptom (Table 3).   Table 3: Participants' Knowledge and Awareness About Conjunctivitis and Retinal Detachment Knowledge and awareness No % Conjunctivitis What is Conjunctivitis? Inflammation of the outer layer of the eyes 90 46.2% Condition in which a thin layer of tissue (the retina) at the back of the eye pulls away from its normal position 39 20.0% Condition in which it damages the optic nerve and is usually associated with increased intraocular pressure 38 19.5% Condition in which the lens of the eye becomes cloudy 28 14.4% Symptoms of Conjunctivitis Eye Itchiness and discharges 115 58.7% Eye pain and redness 92 46.9% Double vision 75 38.3% Headache and vomiting 32 16.3% Loss of vision 44 22.4% What is the 1st thing you will do if you think you have Conjunctivitis? Go to the ophthalmologist 140 71.8% Cover your eye with patch 26 13.3% Use of eye drops that have been prescribed by pharmacist 15 7.7% Regular use of lubricant eye drops 14 7.2% Which of the following is the best practice that should be taken by a Conjunctivitis patient? Use of anti-inflammatory eye drops that have been prescribed by a doctor. 126 64.3% Putting teabags on the eyes 13 6.6% Not to do anything as it is a self-limited condition 23 11.7% Regular use of lubricant eye drops 34 17.3% Retinal detachment What is Retinal detachment? Condition in which a thin layer of tissue (the retina) at the back of the eye pulls away from its normal position 128 65.3% Inflammation of the outer layer of the eyes 25 12.8% Condition in which it damages the optic nerve and is usually associated with increased intraocular pressure 24 12.2% Condition in which the lens of the eye becomes cloudy 19 9.7% Symptoms of Retinal detachment Visual field defects 143 73.0% Eye Itchiness and discharges 48 24.5% Eye pain and redness 51 26.0% Headache and vomiting 35 17.9% Blurred vision 95 48.5% What is the 1st thing you will do if you think you have Retinal detachment? Go immediately to the emergency department 149 76.0% Use of over counter lubricants eye drops 17 8.7% Wash your eye with lukewarm water for 10 minutes 13 6.6% Cover your eye with patch 17 8.7% Which of the following is the best practice that should be taken by a Retinal detachment patient? Regular follow up with an ophthalmologist 158 80.6% Putting teabags on the eyes 16 8.2% Regular use of anti-inflammatory eye drops 13 6.6% Not to do anything as retinal detachment is a self-limited condition 9 4.6%   Knowledge and awareness about chemical burns and corneal abrasions. As for Ocular Chemical burns, 83.2% correctly characterized the case. Regarding Corneal abrasion, 74.5% correctly defined the condition, 65.8% reported Foreign body sensation in the eye, 53.1% reported Eye pain and redness, and 37.8% reported Blurred vision as the main symptoms (Table 4).   Table 4: Participants' Knowledge and Awareness About Eye Diseases, Injuries and First Aid, Continued Knowledge and awareness No % Ocular Chemical Burn What is ocular chemical burn Eye exposure to chemical substance such as perfumes and detergents 163 83.2% Eye Exposure to Fire flame 19 9.7% Eye Exposure to sun rays 14 7.1% Symptoms of ocular Chemical Burn Eye pain and redness 109 55.6% Vision loss/ Blurred vision 88 44.9% Eye dryness 59 30.1% Seeing floaters like specks or lines 97 49.5% Eye tearing 101 51.5% What is the 1st thing you will do if you think you have Chemical Burn of your eyes? Wash your eyes with lukewarm water for at least 20 minutes 87 44.4% Use of over-the-counter lubricants eye drops 14 7.1% Cover your eyes with patches 13 6.6% Do nothing and go to the emergency department/ PHC 82 41.8% When eye injured with acidic material, wash with an alkaline solution and vice versa Disagree 40 20.4% Agree 42 21.4% Don’t know 114 58.2% Corneal abrasion What is corneal abrasion? Scrape or scratch injury of the cornea 146 74.5% Inflammation of the outer layer of the eyes 25 12.8% A condition in which a thin layer of tissue (the retina) at the back of the eye pulls away from its normal position 13 6.6% A condition in which the lens of the eye becomes cloudy 12 6.1% Symptoms of corneal abrasion Foreign body sensation in the eye 129 65.8% Blurred vision 74 37.8% Eye pain and redness 104 53.1% Watery Eye 100 51.0% Seeing floaters like specks or lines 59 30.1% Getting annoyed from light 88 44.9% What is the 1st thing you will do if you think you have corneal abrasion? Go immediately to the emergency department 126 64.3% Use of over counter lubricants eye drops 20 10.2% Wash your eye with water 12 6.1% Cover your eye with patch 23 11.7% Use Eye drops that have been prescribed by pharmacist 12 6.1% Rubbing or excessively touching your eyes 3 1.5% Which of the following is the best practice that should be taken by a corneal abrasion patient? Visit ophthalmologist and follow the instructions 150 76.5% Use alternative medicine methods such as Cautery/ herbs (like tea bags) 13 6.6% Regular washing of the eyes 14 7.1% Not to do anything as Corneal abrasion is a self-limited condition 19 9.7%   As for Chalazion Table 5, 54.6% correctly defined the condition, 67.9% correctly said that it is featured by red, swollen, painful bumps on the eyelids, and 42.9% know that they should go immediately to the emergency department.   Table 5: Participants' Knowledge and Awareness About Eye Diseases, Injuries and First Aid, Continued Chalazion No % What is Chalazion? Painful bumps on the eyelids with redness and swelling 107 54.6% Inflammation of the outer layer of the eyes 25 12.8% inflammation of the edges of the eyelids. 45 23.0% Condition in which the lens of the eye becomes cloudy. 19 9.7% Symptom of Chalazion Red, swollen, painful bump on the eyelids 133 67.9% Seeing floaters like specks or lines 37 18.9% Foreign body sensation inside the eyes 99 50.5% Blurred vision 34 17.3% What is the 1st thing you will do if you think you have Chalazion? Go immediately to the emergency department 84 42.9% Use warm compresses over the eyelid 51 26.0% Try to pop chalazion by pressing or squeezing it 7 3.6% Wash your eyelid with water 17 8.7% Gently massage the eyelid a few times a day 37 18.9%   A total of 86.2% think that it is important to wash your hands before handling your contact lenses. On the other hand, 71.9% did not think it was okay to wash the contact lenses with tap water, and 67.3% disagreed that it is okay to wear weekly lenses for a week without taking them out (Table 6).   Table 6: Participants Knowledge and Awareness About Contact Lens Hygiene Contact lens hygiene No % Do you think it is important to wash your hands before handling your contact lenses? Yes 169 86.2% No 11 5.6% Dont know 16 8.2% After washing your hands Do you think it is important to dry them before handling your contact lenses? Yes 137 69.9% No 25 12.8% Dont know 34 17.3% Do you think it’s ok to wash the contact lenses with tap water? Yes 24 12.2% No 141 71.9% Dont know 31 15.8% It is ok to wear weekly lenses for a week without taking them out? Yes 20 10.2% No 132 67.3% Dont know 44 22.4% It is ok to use refreshing eye drops while wearing the lenses? Yes 81 41.3% No 49 25.0% Dont know 66 33.7% What to do when feeling pain or itchiness while wearing contact lenses? Take them off immediately and visit an ophthalmologist when symptoms persist 144 73.5% Use refreshing eye drops while wearing them 34 17.3% Wash eyes with tap water 9 4.6% Lick to moisturize the lenses 9 4.6%   None of the included demographic factors showed a significant association with their overall knowledge level (Table 7).   Table 7: Factors Associated with Participants' Knowledge and Awareness About Eye Diseases, Injuries, and Hygiene Factors Overall knowledge level p-value Poor Good No % No % Age in years 0.924 16-24 36 46.2% 42 53.8% 25-34 23 54.8% 19 45.2% 35-44 16 47.1% 18 52.9% 45-54 15 48.4% 16 51.6% 55-64 5 45.5% 6 54.5% Gender 0.948 Male 39 48.8% 41 51.3% Female 56 48.3% 60 51.7% Nationality 0.939^ Saudi 92 48.4% 98 51.6% Non-Saudi 3 50.0% 3 50.0% Marital status 0.737 Single 54 49.5% 55 50.5% Married 41 47.1% 46 52.9% Educational level 0.990 Secondary / below 17 48.6% 18 51.4% University degree 69 48.3% 74 51.7% Post-graduate 9 50.0% 9 50.0% Monthly income 0.109 < 5000 SR 15 62.5% 9 37.5% 5000-10000 SR 22 56.4% 17 43.6% 10000-20000 SR 22 44.0% 28 56.0% 20000-40000 SR 14 33.3% 28 66.7% > 40000 SR 22 53.7% 19 46.3%   The highest knowledge score was for Retinal detachment (2.9±1.3; 73.7%), followed by Corneal abrasion (3.7±1.6; 62%), Contact lens hygiene (4.3±1.3; 61.1%), and Conjunctivitis (2.9±1.3; 57.4%), and Glaucoma (3.4±1.3; 56%). The lowest knowledge score was for Ocular Chemical burns (2.5±1.1; 49.7%). The overall knowledge score was 24.5±7.0 out of 42; 58.2% (Figure 1).     Figure 1: Participants' Knowledge Score for Different Eye Diseases, Injurie and Hygiene   A total of 101 (51.5%) had an overall good knowledge and awareness of diseases, injuries, and hygiene, but 95 (48.5%) had a poor knowledge level (Figure 2).     Figure 2: Overall Participants' Knowledge and Awareness About Eye Diseases, Injuries and Hygiene  

Ocular trauma, including corneal epithelial defects (CED) and chemical burns, are prevalent eye injuries. Moshirfar et al. [24] show that the average rate of epithelial defects in SMILE is 3.3%, with a range of 0.17-17.5%. Akgun et al. [25] show that ocular chemical injuries account for 10.7%-34.7% of all chemical burn injuries. CEDs often result from mechanical trauma, especially fingernails, causing symptoms like tearing and photophobia, with long-term risks if untreated [26]. Chemical burns, influenced by pH levels, can cause severe complications if not promptly irrigated [27]. Chalazion, a benign eyelid lesion, commonly affects adults and requires conservative management. According to Stellwagen et al. [28], contact lenses, though beneficial, pose risks due to poor hygiene and cause abrasion and microbial keratitis. In particular, ocular allergies require appropriate treatment to avoid complications. Moreover, there are numerous conditions like retinal detachment, glaucoma, and uveitis, which are serious conditions that require early analysis and treatment to save you from vision loss. Increasing public awareness is critical for prevention and control. Our study assessed the knowledge, mindset, and practice toward eye accidents and first aid among the overall population in Saudi Arabia.   Our results show that knowledge and awareness levels differ significantly among various eye conditions. For glaucoma, a substantial portion of participants (33.2%) could correctly define the condition. This shows that a substantial number of participants are aware of the definition of glaucoma. Similarly, a study by Celebi et al. [29] shows that only 58.8% knew the definition of glaucoma. The awareness of symptoms like vision loss (76.4%) and eye pain (39%) was higher, and most participants (78.5%) knew to seek immediate medical attention. This indicates a relatively good awareness of glaucoma compared to other studies. However, a study by Tchiakpe et al. [30] shows that the majority of respondents could not define glaucoma (68.6%) and had no or inaccurate knowledge of the symptoms (80.7%).   Regarding uveitis, 54.1% of participants could define the condition, and a significant number recognized eye pain (67.3%) and vision loss (35.2%) as symptoms. These findings suggest moderate awareness, aligning with a study by Gaggiano et al. [31], which shows the knowledge of participants about uveitis as proficient in three cases (3.9%), adequate in 12 (15.6%), and sufficient in 13 (16.9%). However, a notable gap exists in recognizing secondary symptoms like headaches, which only 18.9% identified. Moreover, conjunctivitis awareness was relatively high, with 46.2% correctly defining the disease and 58.7% identifying itchiness and discharge as symptoms. Similarly, Silva et al. (2024) show that 74% have adequate knowledge regarding conjunctivitis [32]. Moreover, Arunachalam et al. [33] show that only 15.6% of people had an awareness of red eye (conjunctivitis), about 12.6% were aware of the serious side effects, and <10% were aware of the complication of permanent loss of vision if not treated. The high percentage of participants (71.8%) who know to consult an ophthalmologist indicates a good understanding of appropriate first-aid actions.   In regards the awareness and knowledge about retinal detachment, there is a higher recognition rate, with 65.3% correctly defining the condition and 73% identifying visual field defects as a primary symptom. This awareness is consistent with findings from a study by Kamińska et al. [16] in Poland, where 40% of participants were aware of retinal detachment and identified similar symptoms. The proactive approach of 76% knowing to seek immediate emergency care further emphasizes the high level of awareness.   Chemical burns and corneal abrasions were less well understood. While 83.2% correctly characterized chemical burns, only 44.4% knew the appropriate first aid of washing the eyes with lukewarm water. This aligns with a study by Dhabaan et al. [34] in the Aseer region, Southern Saudi Arabia, which shows that public awareness regarding eye injury first aid in the Aseer region was poor, especially for chemical injuries. For corneal abrasions, 74.5% correctly defined the condition, but only 64.3% knew to seek emergency care, reflecting a need for better education on immediate first aid measures. Similarly, Alhothali et al. [35] show public awareness of eye injury and abrasion first aid was good. Chalazion awareness was moderate, with 54.6% correctly defining the condition. This suggests there is a moderate awareness about chalazion and a need for increased public health education on less common eye conditions [36].   Notably, our study revealed that most participants (86.2%) understood the importance of washing hands before handling contact lenses. However, a previous study by McMonnies et al. [37] shows poor awareness, with only 27% of wearers reporting an awareness that hand hygiene was an important factor in avoiding complications. However, fewer participants (69.9%) recognized the need to dry hands before handling lenses. There was a high awareness about the dangers of using tap water for cleaning lenses (71.9%). Similarly, Ibrahim et al. [38] show that 44.6% of participants believed that there is an increase in complications when rinsing lenses with tap water. Notably, the overall knowledge score was 58.2%, with 51.5% of participants displaying good knowledge. This is similar to the findings of a study by Kasaba et al. [39], which shows that most participants had adequate knowledge, with a score of 81.6%. None of the demographic factors showed a significant association with knowledge levels, suggesting that awareness campaigns should target the entire population rather than specific subgroups.   Comparing our findings with previous literature underscores the variability in public knowledge across different regions. While our study population shows moderate to high awareness of certain conditions, gaps consistent with global trends remain. Tailored educational interventions, leveraging both traditional and digital media, can bridge these gaps and improve overall eye health literacy.

Our study provides valuable insights on the current state of public knowledge, attitudes, and practices regarding eye injuries and first aid among the general population in Saudi Arabia. While the awareness was relatively strong in some areas, such as retinal detachment, notable gaps were evident in others, particularly chemical burns and corneal abrasions, where delays or incorrect responses can have devastating outcomes. These findings highlight the persistent need to strengthen eye health education through general awareness campaigns and practical first aid training in schools, workplaces, and the community. The knowledge gaps were consistent across all demographic groups, suggesting that the challenge is widespread and cannot be addressed by targeting a single population segment. Instead, a comprehensive, nationwide approach is required. By equipping individuals with the skills to recognize emergencies and respond appropriately, we can reduce unnecessary emergency visits, improve patient outcomes, and ultimately preserve vision on a broader scale. In conclusion, our study highlights the importance of continuous public health education to enhance awareness and promote effective first aid practices, ultimately improving eye health outcomes.   Disclosures Human subjects: All authors have confirmed that this study did not involve human participants or tissue.   Animal subjects All authors have confirmed that this study did not involve animal subjects or tissue.   Conflicts of interest In compliance with the ICMJE uniform disclosure form, all authors declare the following   Payment and Services Info All authors have declared that no financial support was received from any organization for the submitted work.   Financial Relationships All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work.   Other Relationships All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work.