!2.06 Corneal Abrasion
The patient may complain of eye pain or a foreign body sensation after being
poked in the eye with a finger or twig. The patient may have abraded the
cornea inserting or removing contact lenses. Removal of a corneal foreign body
produces some corneal abrasion, but corneal abrasion can even occur without
identifiable trauma. There is often excessive tearing and photophobia. Often
the patient cannot open his eye for the exam. Abrasions are occasionally
visible on sidelighting the cornea. Conjunctival inflammation can range from
nothing to severe conjunctivitis with accompanying iritis.
What to do:
* Instill topical anesthetic drops (to permit exam).
* Perform a complete eye exam (visual acuity, funduscopy, anterior chamber
bright light, conjunctival sacs for foreign body).
* Perform the fluorescein exam by wetting a paper strip impregnated with dry
orange fluorescein dye and touching this strip into the tear pool inside
the lower conjunctival sac. After the patient blinks, darken the room and
examine the patient's eye under cobalt blue or ultraviolet light (the
red-free light on the ophthalmoscope does not work). Areas of denuded or
devitalized corneal epithelium will fluoresce green.
* If a foreign body is present, remove it and irrigate the eye.
* If iritis is present (evidenced by photophobia, an irregular pupil or
meiosis, and a limbic blush in addition to conjunctival injection) consult
the ophthalmologic followup physician about starting the patient on topical
mydriatics and steroids (e.g., cyclopentolate or homatropine and
* Instill antibiotic ointment (e.g., erythromycin, tobramycin) in the lower
sac. A small, superficial, non-painful abrasion may be left uncovered.
* For large, deep, and painful abrasions, patch the eye with enough pressure
to keep the lid closed by folding one eyepatch double to rest against the
lid, covering it with a second unfolded eyepatch, and taping both tightly
with several strips of 1" tape running from the cheek to mid forehead.
* Prescribe analgesics (e.g., oxycocone, ibuprofen, naproxen), and give the
* Warn the patient the pain will return when the local anesthetic wears off.
* Make an appointment for ophthalmologic followup to reevaluate the abrasion
the next day.
What not to do:
* Do not be stingy with pain medication. Patching alone will not eliminate
* Do not give patient any topical anesthetic for continued instillation.
* Do not patch a patient with a bacterial conjunctivitis or ulcer.
* Do not tape an eye patch up and down or across the nose.
Corneal abrasions are a loss of the superficial epithelium of the cornea. They
are generally a painful injury, because of the extensive innervation. Healing
is usually complete in one to two days unless there is extensive epithelial
loss of underlying ocular disease (e.g., diabetes). Scarring will occur onlly
if the injury is deep enough to penetrate into the collagenous layer.
Fluorescein binds to corneal stroma and devitalized epithelium, but not to
intact corneal epithelium. Collections of fluorescein elsewhere, in
conjunctival irregularities and in the tear film, are not pathological.
Continuous instillation of topical anesthetic drops can impair healing,
inhibit protective reflexes, permit further eye injury, and even cause
sloughing of the corneal epithelium. If the abrasion is small or the patient
is significantly distressed by patching, topical antibiotic drops or ointment
can be used alone. The patch does not significantly improve healing or pain
With small superficial abrasions the patient does not require follow up if he
is completely asymptomatic in 12-24 hours. With larger abrasions or with any
persistant discomfort, ophthalmologic follow up is necessary because of the
risk of corneal infection or ulceration.
Hard contact lenses can abrade the cornea, but can also cause diffuse ischemic
damage when worn for more,.than 12 hours at a time, by depriving the avascular
corneal epithelium of oxygen and nutrients in the tear layer.
* Kirkpatrick J: No eye pad for corneal abrasions. Eye 1993;7:468
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