Conjunctival abrasion
Background
- Superficial disruption of the conjunctival epithelium from trauma, foreign body, or chemical exposure
- Conjunctiva has less innervation than cornea → patients are far less symptomatic than with corneal abrasion
- Heals rapidly (typically within 24-48 hours)
Clinical Features
- Foreign body sensation
- Mild pain or irritation
- Tearing, mild redness
- Photophobia (rare)
- Subconjunctival hemorrhage may be present
Differential Diagnosis
- Corneal abrasion
- Conjunctival laceration
- Subconjunctival hemorrhage
- Conjunctivitis
- Open globe injury (must rule out with high-energy mechanism)
Evaluation
- Visual acuity
- Slit-lamp exam with fluorescein staining — conjunctival uptake without corneal involvement
- Seidel test to rule out globe perforation (especially if mechanism of concern)
- Evert eyelids to look for retained foreign body
Management
- Remove any conjunctival foreign bodies
- Erythromycin ointment 0.5% QID × 2-3 days (prophylaxis)
- Artificial tears PRN for comfort
- Suturing is almost never required (conjunctiva heals rapidly)
- No eye patching needed
Disposition
- Discharge with erythromycin ointment
- Follow-up only if worsening symptoms; most heal within 24-48 hours