Corneal Abrasion

  • Traumatic erosion of corneal surface
  • Usually confined to surface epithelium
  • Caused by accidental contact with fingernails, hairbrush bristles, branches or bushes, and airborne particles, or from poor contact lens technique and overwear
  • Instill topical anesthetic to allow pain-free examination
  • Measure visual acuity
  • Inspect cornea with penlight, loupe, biomicroscope
  • Instill fluorescein dye; cobalt blue light enhances green fluorescence
  • Evert upper lid to hunt for foreign body in pre-tarsal sulcus
  • Remove foreign body with cotton-tipped applicator
  • Instill topical antibiotic (optional)
  • Patch firmly to relieve pain unless you suspect infection
  • Prescribe pain medication
  • Arrange follow-up examination in 24 hours
  • Small abrasions usually heal within a day without consequences
  • Large abrasions are painful and can become infected
  • Abrasions that penetrate beneath surface epithelium will heal with scar formation and impair vision
  • Undetected perforation may lead to intraocular infection (endophthalmitis) and severe vision loss
  • Healed epithelium may adhere poorly and peel off with minimal provocation, commonly after waking from sleep ("recurrent corneal erosion")
  • Recurrent corneal erosion requires preventive ophthalmologic measures