Corneal abrasion

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Background

  • Must rule-out intraocular foreign body and corneal laceration

Clinical Features

  • Foreign body sensation
  • Photophobia (+/- consensual)
  • Decreased vision
    • If associated iritis or if abrasion occurs in visual axis
  • Relief of pain with topical anesthesia
    • Virtually diagnostic of corneal abrasion
Corneal Abrasions from Airbag Deployment
Corneal Abrasions from Airbag Deployment

Differential Diagnosis

Unilateral Red Eye

^Emergent diagnoses

^^Critical diagnoses

Evaluation

  • A complete eye exam should be conducted
  • Eyelid Exam
    • Flip upper lid and exam lower lid for FB
    • If concern for FB despite normal exam, consider orbital CT or MRI is certain it is nonmetallic
  • Fluorescein Exam
    • Apply 1 gtt of flourescein or utilize strip with anesthetic
    • Use Wood's Lamp or Slit Lamp with colbalt blue light
    • Fluoresceine will fill corneal defects and glow
    • Multiple vertical abrasions suggests foreign body embedded under the upper lid

Additional Considerations

  • Contact lens wearer
    • If white spot or opacity on exam concerning for infiltrate or ulceration refer for same day ophtho appt
  • Fluorescein Examination
  • Visual acuity
    • If poor, consider corneal edema versus infectious infiltrate
  • Pupil shape and reactivity
    • Irregular or nonreactive pupil suggests pupillary sphincter injury and possible penetrating trauma
  • Hyphema or hypopyon
    • Hyphema suggests possible penetrating injury
    • If present then same same-day ophtho consult is required
  • Extruded ocular contents
    • If yes then place eye shield and obtain emergent ophtho referral
  • Corneal Ulcer
    • Grayish white lesion
    • Worsening symptoms >1day

Management

Antibiotics

Does Not Wear Contact Lens

Wears Contact Lens

Antibiotics should cover pseudomonas and favor 3rd or 4th generation fluoroquinolones

  • Levofloxacin 0.5% solution 2 drops ever 2 hours for 2 days THEN q6hrs for 5 days OR
  • Moxifloxacin 0.5% solution 2 drops every 2 hours for 2 days THEN q6hrs for 5 days OR
  • Tobramycin 0.3% solution 2 drops q6hrs for 5 days OR
  • Gatifloxacin 0.5% solution 2 drops every 2 hours for 2 days THEN q6hrs for 5 days OR
  • Gentamicin 0.3% solution 2 drops six times for 5 days

Analgesia

  • Systemic NSAIDs or opioids
  • Cycloplegics can be consider for patients with large abrasions (>2mm) and/or severe pain
  • Ophthalmic NSAIDs
  • Topical anesthetics
    • Tetracaine 1% 1 drop q30min has been found to be safe in the first 24 hrs[1]

Other

  • Tetanus prophylaxis not indicated (unless penetrating injury)[2]
  • Patch is not routinely recommended[3] and can prolong healing time[4]

Disposition

  • Ophtho follow up in 48h for routine cases
  • Minor abrasions will heal in 48-72h

References

  1. Waldman N, et al. Topical tetracaine used for 24 hours is safe and rated highly effective by patients for the treatment of pain caused by corneal abrasions: a double-blind, randomized clinical trial. Acad Emerg Med. 2014; 21(4):374-82.
  2. Mukherjee P, et al. Tetanus prophylaxis in superficial corneal abrasions. Emerg Med J. 2003; 20:62-64.
  3. Flynn CA, et al. Should we patch corneal abrasions? A meta-analysis. J Fam Pract. 1998; 47(4):264-70.
  4. Fraser, S. Corneal abrasion. Clin Ophthalmol. 2010; 4:387-390.

See Also