Corneal abrasion

Diagnosis

Visual acuity
1. If substantially subnormal evaluate for corneal edema versus infectious infiltrate
Pupil shape and reactivity
1. Irregular or nonreactive pupil suggests pupillary sphincter injury
  1. Evaulate for penetrating injury
Hyphema or hypopyon?
1. If yes then same same-day ophtho consult is required
2. Hyphema suggests possible penetrating injury
Extruded ocular contents?
1. If yes then place eye shield and obtain emergent ophtho referral
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
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 Zoster Ophthalmicus
Corneal Ulcer?
1. Grayish white
2. Worsening symptoms
3. > 1day
Intraocular foreign body?
1. If concern for foreign body but none visualized on external exam consider CT orbit

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
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
Tetanus prophylaxis
1. Only indicated for penetrating injuries, not for abrasions or foreign bodies