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2.06 Corneal Abrasion


Presentation

The patient may complain of eye pain or a foreign body sensation after being poked in the eye with a finger or twig. The patient may have abraded the cornea inserting or removing contact lenses. Removal of a corneal foreign body produces some corneal abrasion, but corneal abrasion can even occur without identifiable trauma. There is often excessive tearing and photophobia. Often the patient cannot open his eye for the exam. Abrasions are occasionally visible on sidelighting the cornea. Conjunctival inflammation can range from nothing to severe conjunctivitis with accompanying iritis.

What to do:

What not to do:

Discussion

Corneal abrasions are a loss of the superficial epithelium of the cornea. They are generally a painful injury, because of the extensive innervation. Healing is usually complete in one to two days unless there is extensive epithelial loss of underlying ocular disease (e.g., diabetes). Scarring will occur onlly if the injury is deep enough to penetrate into the collagenous layer.

Fluorescein binds to corneal stroma and devitalized epithelium, but not to intact corneal epithelium. Collections of fluorescein elsewhere, in conjunctival irregularities and in the tear film, are not pathological.

Continuous instillation of topical anesthetic drops can impair healing, inhibit protective reflexes, permit further eye injury, and even cause sloughing of the corneal epithelium. If the abrasion is small or the patient is significantly distressed by patching, topical antibiotic drops or ointment can be used alone. The patch does not significantly improve healing or pain relief.

With small superficial abrasions the patient does not require follow up if he is completely asymptomatic in 12-24 hours. With larger abrasions or with any persistant discomfort, ophthalmologic follow up is necessary because of the risk of corneal infection or ulceration.

Hard contact lenses can abrade the cornea, but can also cause diffuse ischemic damage when worn for more,.than 12 hours at a time, by depriving the avascular corneal epithelium of oxygen and nutrients in the tear layer.

References


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from Buttaravoli & Stair: COMMON SIMPLE EMERGENCIES
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Craig Feied, MD
Mark Smith, MD
Jon Handler, MD
Michael Gillam, MD