corneal abrasions

see also:

• ophthalmology
• chemical injuries and burns to the eyes
• welder flash burns - UV keratopathy (photo keratitis)
• Eye injuries
• RCH guideline - acute eye injuries in children
• RCH guideline - penetrating eye injury
• RCH guideline - the acute red eye

• Vic DHS - Eye injury - Flash burns (pdf)
• Vic DHS - Eye injury - Foreign body (pdf)

• patients with a possible open globe injury should be examined with extreme caution, and clinicians must avoid placing pressure on the globe (eg, with lid eversion or foreign body [FB] removal) or using eye drops until this injury is ruled out.

• possible open globe injury or penetrating injury
  • corneal laceration
  • mechanism of injury suggestive of penetrating trauma eg. hammering, drilling
• corneal infection
  • assess for corneal infiltrate / anterior chamber cells (“AC reaction”)
  • increased risk if contaminated object caused the abrasion eg. plants
• retained foreign body - this is likely if there are vertical linear abrasions
• patients at risk of recurrent erosion syndrome (RES)
  • sharp objects such as paper, fingernail, tree branch, FB or plant
  • other risk factors, corneal dystrophies (eg. epithelial basement membrane dystrophy (EBMD)), diabetes, ocular rosacea, dry eye syndrome
  • major recurrent attacks occur with a median of 60 days
  • some have daily minor issues on waking - perhaps related to REM sleep
  • Mx is mainly long term use of lubricating ointment each night +/- doxycycline/topical steroids

• evert upper eyelid to exclude FB
• use slit lamp with cobalt blue light and fluorescein stain to document position and size
• perform Seidel test to exclude laceration:
  • application of flourescein drops near a laceration results in loss of the green pigment streaming away from site of laceration due to dilution from aqueous humor (do not use the strips near lacerations)
  • see Youtube demo

• if suspect infection, laceration or AC reaction, contact ophthalmology
• if FB present, remove it
• if no infection or laceration:
  • chloramphenicol ointment or drops qid for 3-5 days
  • if severe pain, consider stat dose of cycloplegic (eg. homatropine 2% drops)
  • avoid eye pads as they tend to delay healing although if there is a large epithelial defect, a double eye pad may be used for 24hrs to reduce discomfort
  • do NOT pad the eye if caused by a plant
  • do NOT give LA drops to take home
  • dim lights, cool compresses, rest, oral analgesia prn
  • if risk of RES then consider paraffin based lubricant ointment (eg. Refresh nighttime, Polyvisc) nocte for 3 months
  • consider follow up by ophthalmology (or perhaps GP) if either:
    • plant or organic matter caused the abrasion
    • symptoms not improving within 48hrs
    • unable to evert eyelid to exclude FB - eg. children
  • patient information:
    • advise the pain will return when the LA wears off and this may feel like they still have a FB
    • return if increasing pain or decreased vision
    • advise of risk of RES
    • if wears contact lens, discard previous lens and resume contact lens wear with a fresh lens once has been asymptomatic for 1 week