Corneal abrasion

Background

1. Must rule-out intraocular foreign body and corneal laceration

Clinical Features

1. Foreign body sensation
2. Photophobia (+/- consensual)
3. Decreased vision
   1. If associated iritis or if abrasion occurs in visual axis
4. Relief of pain with topical anesthesia
   1. Virtually diagnostic of corneal abrasion

Diagnosis

1. Visual acuity
   1. If substantially subnormal evaluate for corneal edema versus infectious infiltrate
2. Pupil shape and reactivity
   1. Irregular or nonreactive pupil suggests pupillary sphincter injury
      1. Evaulate for penetrating injury
3. Hyphema or hypopyon?
   1. If yes then same same-day ophtho consult is required
   2. Hyphema suggests possible penetrating injury
4. Extruded ocular contents?
   1. If yes then place eye shield and obtain emergent ophtho referral
5. Contact lens wearer?
   1. If yes AND e/o white spot or opacity on exam concerning for infiltrate or ulceration ###Refer for same day ophtho appt
6. Fluorescein Examination
   1. Seidel sign (streaming of fluorescein caused by leaking aqueous humor)
      1. Indicates penetrating trauma (globe microperforation)
   2. Multiple vertical abrasions suggests foreign body embedded under the upper lid
   3. Branching pattern suggests possible Herpes Zoster Ophthalmicus
7. Corneal Ulcer?
   1. Grayish white
   2. Worsening symptoms >1day
8. Intraocular foreign body?
   1. If concern for foreign body but none visualized on external exam consider CT orbit

DDx

1. Corneal Ulcer
2. Herpes Zoster Ophthalmicus
3. Corneal laceration
4. Intra-ocular foreign body

Foreign Body Removal

1. Anesthetize eye
   1. Irrigate with NS
2. Moistened cotton swab
3. 25G needle
   1. Approach from tangential angle

Treatment

1. Antibiotics - Indicated for all abrasions
   1. Ointment is better than drops due to its lubricant effect
      1. Erythromycin ointment qid x 3-5d
   2. If treatintg contact lens associated abrasion must cover pseudomonas
      1. Cipro/ofloxacin or tobramycin drops qid x 3-5d
2. Analgesia
   1. Cycloplegics
      1. Consider for patients with large abrasions (>2mm) and/or severe pain
         1. Cyclopentolate 1% 1 drop q6-8hr
   2. Systemic opiods
   3. Never give Rx for topical anesthetics
3. Tetanus prophylaxis
   1. Only indicated for penetrating injuries, not for abrasions or foreign bodies
4. Rust Ring
   1. Not necessary to remove in the ED; refer to ophtho for definitive removal

Disposition

1. Ophtho f/u in 48h for routine cases
2. Ophtho f/u in 24h for rust ring removal

Source

• UpToDate
• Tintinalli

See Also

• Corneal Ulcer
• Conjunctival Abrasion