Corneal abrasion
Diagnosis
- Visual acuity
- If substantially subnormal evaluate for corneal edema versus infectious infiltrate
- Pupil shape and reactivity
- Irregular or nonreactive pupil suggests pupillary sphincter injury
- Evaulate for penetrating injury
- Irregular or nonreactive pupil suggests pupillary sphincter injury
- Hyphema or hypopyon?
- If yes then same same-day ophtho consult is required
- Hyphema suggests possible penetrating injury
- Extruded ocular contents?
- If yes then place eye shield and obtain emergent ophtho referral
- Contact lens wearer?
- If yes and p/w corneal abrasion AND e/o white spot or opacity on exam concerning for infiltrate or ulceration then refer for same day ophtho appt
- Fluorescein Examination
- Seidel sign (streaming of fluorescein caused by leaking aqueous humor)
- Indicates penetrating trauma (globe microperforation)
- Branching pattern suggests possible herpes keratitis
- Seidel sign (streaming of fluorescein caused by leaking aqueous humor)
- Corneal Ulcer?
- Grayish white
- Worsening symptoms
- > 1day
- Intraocular foreign body?
- If concern for foreign body but none visualized on external exam consider CT orbit
DDx
Foreign Body Removal Techniques
- Irrigation
- Cotton swab
- 18-25G needle
Treatment
- Antibiotics - Indicated for all abrasions
- Ointment is better than drops due to its lubricant effect
- Erythromycin ointment qid x 3-5 days
- If treatintg contact lens associated abrasion must cover pseudomonas
- E.g. Cipro/ofloxacin or tobramycin drops qid x 3-5 days
- Ointment is better than drops due to its lubricant effect
- Analgesia
- Cycloplegics
- Consider for patients with large abrasions and photophobia
- Cyclopentolate 0.5-1% bid or homatropine 2.5-5% daily for up to 48 hours
- Consider for patients with large abrasions and photophobia
- Systemic opiods
- Never give Rx for topical anesthetics
- Cycloplegics
- Tetanus prophylaxis
- Only indicated for penetrating injuries, not for abrasions or foreign bodies
Rust Ring
- Treat just like pts with corneal abrasions
- obtain ophtho f/u in 24-48 hrs for removal of the rust