Corneal abrasion

Corneal abrasions are generally a result of trauma to the surface of the eye. Common causes include a fingernail scratching the eye, walking into a tree branch and getting grit in the eye, particularly if the eye is then rubbed. Injuries can also be caused by contact lens insertion and removal, but beware the possibility of a corneal ulcer in contact lens wearers, especially those who wear soft lenses.

Symptoms

  • Immediate pain
  • Watering
  • Foreign body sensation
  • Light sensitivity   

Signs

  • Fluorescein drops will stain the abraded area 

Eye examination

  • Observe conjunctiva and cornea with white light to exclude foreign body or corneal clouding
  • Instil 1 drop of proxymetacaine 0.5% with fluorescein 0.25%
  • Observe for corneal staining (preferably using a blue light source)
  • Evert upper eye lid if any history of foreign body in the eye
  • Watch out for signs of a corneal laceration such as a shallow AC or distorted pupil 

Treatment

  • Give patient corneal abrasion information leaflet
  • Instil chloramphenicol ointment 1% stat
  • Double eye pad secured with three strips of tape (to remain on for 12 – 24 hours) – inform patient that this can be removed if this is uncomfortable and advise use of sunglasses
  • Oc chloramphenicol qds for 5 days after removal of pad or immediately in patients not padded
  • Advise oral analgesia, ibuprofen based if able to tolerate
  • Review as appropriate