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corneal_abrasion

corneal abrasions

patient information sheets

introduction

  • 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.

red flags to exclude

  • 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

assessment

  • 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)

management

  • 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
corneal_abrasion.txt · Last modified: 2018/09/10 08:42 by 127.0.0.1

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