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 fluorescenceEvert 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 infectionPrescribe pain medication Arrange follow-up examination in 24 hours DO NOT prescribe topical anesthetics outside of the examination room
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
