Corneal abrasion

• Corneal abrasions are scratches or damage to the cornea. 
• Common causes include:

  • Damaged contact lenses
  • Fingernails
  • Foreign bodies (e.g., metal fragments)
  • Tree branches 
  • Makeup brushes
  • Entropion (inward turning eyelid)
• Abrasions associated with contact lenses may be associated with Pseudomonas infection. An important differential is herpes keratitis, which requires antiviral treatment
• There is often a history of trauma, followed by:

  • Painful red eye
  • Photophobia
  • Foreign body sensation
  • Epiphora (excessive tear production)
  • Blurred vision
• Visual acuity is unaffected unless the injury involves the visual axis (in front of the pupil).
• Exam:

  • Fluorescien 2% dye
  • Under blue light
  • Epithelial injury will glow green
• Removing the foreign body is essential to prevent secondary microbial keratitis.

  • Topical anaesthetic drops
  • Irrigation with normal saline may help dislodge particles
  • Cotton bud to remove
  • Hypodermic needle should only be used with appropriate training and under slit lamp magnification
  • Prophylactic topical antibiotic ointment
• Simple abrasions:

  • Heal within 48-72 hours
  • Topical prophylactic antibiotic ointment
  • Oral analgesics
• Mild, uncomplicated abrasions may be managed in primary care where there is appropriate experience and skill. Uncomplicated corneal abrasions usually heal over 2-3 days. More complicated cases require assessment and management by ophthalmology.