Corneal abrasion: Difference between revisions
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==Background==
==Background==
*Must rule-out intraocular foreign body and corneal laceration
*Must rule-out intra[[ocular foreign body]] and corneal laceration


==Clinical Features==
==Clinical Features==
*Foreign body sensation
*Foreign body sensation
*Photophobia (+/- consensual)
*Photophobia (+/- consensual)
*Decreased vision
*[[Vision loss|Decreased vision]]
**If associated iritis or if abrasion occurs in visual axis
**If associated iritis or if abrasion occurs in visual axis
*Relief of pain with topical anesthesia
*[[Eye pain]]
**Virtually diagnostic of corneal abrasion
**Relief of [[eye pain|pain]] with topical anesthesia
***Virtually diagnostic of corneal abrasion
[[File:Airbag-corneal-abrasion1.png|thumb|Corneal Abrasions from Airbag Deployment]]
[[File:Airbag-corneal-abrasion1.png|thumb|Corneal Abrasions from Airbag Deployment]]
[[File:Airbag-corneal-abrasion2.png|thumb|Corneal Abrasions from Airbag Deployment]]
[[File:Airbag-corneal-abrasion2.png|thumb|Corneal Abrasions from Airbag Deployment]]
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*A complete [[Eye Exam|eye exam]] should be conducted
*A complete [[Eye Exam|eye exam]] should be conducted
*Eyelid Exam
*Eyelid Exam
**Flip upper lid and exam lower lid for FB
**Flip upper lid and exam lower lid for foreign body
**If concern for FB despite normal exam, consider orbital CT or MRI is certain it is nonmetallic  
**If concern for foreign body despite normal exam, consider orbital CT or MRI if certain foreign body is nonmetallic  
*Fluorescein Exam
*Fluorescein Exam
**Apply 1 gtt of flourescein or utilize strip with anesthetic
**Apply 1 gtt of flourescein or use strip with anesthetic
**Use Wood's Lamp or Slit Lamp with colbalt blue light
**Use Wood's lamp or [[slit lamp]] with cobalt blue light
**Fluoresceine will fill corneal defects and glow
**Fluorescein will fill corneal defects and glow
**Multiple vertical abrasions suggests foreign body embedded under the upper lid
**Multiple vertical abrasions suggests foreign body embedded under the upper lid


===Additional Considerations===
===Additional Considerations===
*Contact lens wearer
*[[contact lens problems|Contact lens]] wearer
**If white spot or opacity on exam concerning for infiltrate or ulceration refer for same day ophtho appt  
**If white spot or opacity on exam concerning for infiltrate or ulceration refer for same day ophtho appt  
*Fluorescein Examination
*Fluorescein Examination
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*Pupil shape and reactivity
*Pupil shape and reactivity
**Irregular or nonreactive pupil suggests pupillary sphincter injury and possible penetrating trauma
**Irregular or nonreactive pupil suggests pupillary sphincter injury and possible penetrating trauma
*[[Traumatic hyphema|Hyphema]] or hypopyon
*[[Traumatic hyphema|Hyphema]] or [[hypopyon]]
**Hyphema suggests possible penetrating injury  
**Hyphema suggests possible penetrating injury  
**If present then same same-day ophtho consult is required
**If present then same same-day ophtho consult is required
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*[[Corneal Ulcer]]
*[[Corneal Ulcer]]
**Grayish white lesion
**Grayish white lesion
**Worsening symptoms >1day  
**Worsening symptoms >1day


==Management==
==Management==
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{{Corneal Abrasion Antibiotics}}
{{Corneal Abrasion Antibiotics}}


===Analgesia===
===[[Analgesia]]===
*Systemic [[NSAIDs]] or opioids
*Systemic [[NSAIDs]] or [[opioids]]
*Cycloplegics can be consider for patients with large abrasions (>2mm) and/or severe pain
*[[Cycloplegic]]s can be consider for patients with large abrasions (>2mm) and/or severe pain
**[[Cyclopentolate]] 1% 1 drop q6-8hr
**[[Cyclopentolate]] 1% 1 drop q6-8hr
*Ophthalmic [[NSAIDs]]
*Ophthalmic [[NSAIDs]]
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===Other===
===Other===
*Tetanus prophylaxis not indicated (unless penetrating injury)<ref>Mukherjee P, et al. Tetanus prophylaxis in superficial corneal abrasions. Emerg Med J. 2003; 20:62-64.</ref>
*[[Tetanus prophylaxis]] not indicated (unless penetrating injury)<ref>Mukherjee P, et al. Tetanus prophylaxis in superficial corneal abrasions. Emerg Med J. 2003; 20:62-64.</ref>
*Patch is not routinely recommended<ref>Flynn CA, et al. Should we patch corneal abrasions? A meta-analysis. J Fam Pract. 1998; 47(4):264-70.</ref> and can prolong healing time<ref>Fraser, S. Corneal abrasion. Clin Ophthalmol. 2010; 4:387-390.</ref>
*Patch is not routinely recommended<ref>Flynn CA, et al. Should we patch corneal abrasions? A meta-analysis. J Fam Pract. 1998; 47(4):264-70.</ref> and can prolong healing time<ref>Fraser, S. Corneal abrasion. Clin Ophthalmol. 2010; 4:387-390.</ref>


==Disposition==
==Disposition==
*Ophtho follow up in 48h for routine cases
*Ophtho follow up in 48h for routine cases
*Minor abrasions will heal in 48h
*Minor abrasions will heal in 48-72h


==References==
==References==

Revision as of 17:02, 5 October 2019

Background

Clinical Features

  • Foreign body sensation
  • Photophobia (+/- consensual)
  • Decreased vision
    • If associated iritis or if abrasion occurs in visual axis
  • Eye pain
    • Relief of pain with topical anesthesia
      • Virtually diagnostic of corneal abrasion
Corneal Abrasions from Airbag Deployment
Corneal Abrasions from Airbag Deployment

Differential Diagnosis

Unilateral red eye

^Emergent diagnoses ^^Critical diagnoses

Evaluation

  • A complete eye exam should be conducted
  • Eyelid Exam
    • Flip upper lid and exam lower lid for foreign body
    • If concern for foreign body despite normal exam, consider orbital CT or MRI if certain foreign body is nonmetallic
  • Fluorescein Exam
    • Apply 1 gtt of flourescein or use strip with anesthetic
    • Use Wood's lamp or slit lamp with cobalt blue light
    • Fluorescein will fill corneal defects and glow
    • Multiple vertical abrasions suggests foreign body embedded under the upper lid

Additional Considerations

  • Contact lens wearer
    • If white spot or opacity on exam concerning for infiltrate or ulceration refer for same day ophtho appt
  • Fluorescein Examination
  • Visual acuity
    • If poor, consider corneal edema versus infectious infiltrate
  • Pupil shape and reactivity
    • Irregular or nonreactive pupil suggests pupillary sphincter injury and possible penetrating trauma
  • Hyphema or hypopyon
    • Hyphema suggests possible penetrating injury
    • If present then same same-day ophtho consult is required
  • Extruded ocular contents
    • If yes then place eye shield and obtain emergent ophtho referral
  • Corneal Ulcer
    • Grayish white lesion
    • Worsening symptoms >1day

Management

Antibiotics

Does Not Wear Contact Lens

Wears Contact Lens

Antibiotics should cover pseudomonas and favor 3rd or 4th generation fluoroquinolones

  • Levofloxacin 0.5% solution 2 drops ever 2 hours for 2 days THEN q6hrs for 5 days OR
  • Moxifloxacin 0.5% solution 2 drops every 2 hours for 2 days THEN q6hrs for 5 days OR
  • Tobramycin 0.3% solution 2 drops q6hrs for 5 days OR
  • Gatifloxacin 0.5% solution 2 drops every 2 hours for 2 days THEN q6hrs for 5 days OR
  • Gentamicin 0.3% solution 2 drops six times for 5 days

Analgesia

Other

Disposition

  • Ophtho follow up in 48h for routine cases
  • Minor abrasions will heal in 48-72h

References

  1. ↑ Waldman N, et al. Topical tetracaine used for 24 hours is safe and rated highly effective by patients for the treatment of pain caused by corneal abrasions: a double-blind, randomized clinical trial. Acad Emerg Med. 2014; 21(4):374-82.
  2. ↑ Mukherjee P, et al. Tetanus prophylaxis in superficial corneal abrasions. Emerg Med J. 2003; 20:62-64.
  3. ↑ Flynn CA, et al. Should we patch corneal abrasions? A meta-analysis. J Fam Pract. 1998; 47(4):264-70.
  4. ↑ Fraser, S. Corneal abrasion. Clin Ophthalmol. 2010; 4:387-390.

See Also

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