Corneal abrasion

Diagnosis

1. Visual acuity
   1. If substantially subnormal evaluate for corneal edema versus infectious infiltrate
2. Pupil shape and reactivity
   1. Irregular or nonreactive pupil suggests pupillary sphincter injury
      1. Evaulate for penetrating injury
3. Hyphema or hypopyon?
   1. If yes then same same-day ophtho consult is required
   2. Hyphema suggests possible penetrating injury
4. Extruded ocular contents?
   1. If yes then place eye shield and obtain emergent ophtho referral
5. Contact lens wearer?
   1. If yes and p/w corneal abrasion AND e/o white spot or opacity on exam concerning for infiltrate or ulceration then refer for same day ophtho appt
6. Fluorescein Examination
   1. Seidel sign (streaming of fluorescein caused by leaking aqueous humor)
      1. Indicates penetrating trauma (globe microperforation)
   2. Branching pattern suggests possible herpes keratitis
7. Corneal Ulcer?
   1. Grayish white
   2. Worsening symptoms
   3. > 1day
8. Intraocular foreign body?
   1. If concern for foreign body but none visualized on external exam consider CT orbit

DDx

Corneal Ulcer

Foreign Body Removal Techniques

1. Irrigation
2. Cotton swab
3. 18-25G needle

Treatment

1. Antibiotics - Indicated for all abrasions
   1. Ointment is better than drops due to its lubricant effect
      1. Erythromycin ointment qid x 3-5 days
   2. If treatintg contact lens associated abrasion must cover pseudomonas
      1. E.g. Cipro/ofloxacin or tobramycin drops qid x 3-5 days
2. Analgesia
   1. Cycloplegics
      1. Consider for patients with large abrasions and photophobia
         1. Cyclopentolate 0.5-1% bid or homatropine 2.5-5% daily for up to 48 hours
   2. Systemic opiods
   3. Never give Rx for topical anesthetics
3. Tetanus prophylaxis
   1. Only indicated for penetrating injuries, not for abrasions or foreign bodies

Rust Ring

1. Treat just like pts with corneal abrasions
2. obtain ophtho f/u in 24-48 hrs for removal of the rust