Dr. Orwa Nasser MD MPH - Corneal Abrasion

Corneal Abrasion

A corneal abrasion is a scratch or scrape on the cornea, the clear dome-shaped front surface of the eye that helps focus light and protect internal structures. The cornea contains many nerve endings, which makes even small abrasions very painful. Most corneal abrasions are superficial and heal quickly with appropriate care. Untreated abrasions can lead to infection, including corneal ulcer, which may threaten vision.

Symptoms:

    ·    Sharp eye pain.

    ·    Redness of the eye.

    ·    Excessive tearing.

    ·    Sensitivity to light.

    ·    Blurred vision.

    ·    Foreign-body sensation.

    ·    Headache due to eye discomfort.

    ·    Difficulty keeping the eye open.

    ·    Symptoms may worsen during the first several hours after injury.

Causes:

·    Mechanical Trauma: Common causes include fingernails, paper edges, plant material, airborne debris, or cosmetic applicators.

·    Contact Lens Use: Improper handling, sleeping in lenses, or wearing damaged lenses can injure the corneal epithelium. Contact lenses may also trap debris against the cornea and increase infection risk.

·    Foreign Bodies: Small particles trapped under the eyelid may repeatedly scrape the cornea while blinking.

·    Dry Eye and Surface Disorders: Reduced tear protection makes the cornea more vulnerable to injury.

Diagnosis and Tests:

·    Diagnosis requires a careful eye examination.

·    Visual acuity testing establishes baseline vision.

·    Slit-lamp examination allows magnified inspection of the cornea.

·    Fluorescein staining highlights epithelial defects under blue light. Foreign bodies, if present, are carefully removed.

Management and Treatment: Treatment focuses on pain control, infection prevention, and promoting healing.

·    Antibiotic Eye Drops or Ointment: Topical antibiotics are prescribed to reduce the risk of secondary infection.

·    Pain Management:

o   Lubricating drops and oral pain relievers may improve comfort.

o   Cycloplegic drops may be used in selected cases to reduce ciliary spasm.

o   Topical anesthetic drops should not be used at home because they may delay healing.

·    Contact Lens Discontinuation: Contact lenses must be discontinued until complete healing is confirmed.

·    Healing Timeline: Most superficial corneal abrasions heal within 24 to 72 hours. Larger abrasions may require longer healing and close follow-up.

Prognosis: The prognosis for corneal abrasion is generally excellent with prompt treatment. The corneal epithelium regenerates rapidly. Complications may occur if infection develops. Recurrent corneal erosion may develop if healing is incomplete.

Prevention:

·    Wear protective eyewear during sports or hazardous activities.

·    Handle contact lenses carefully and follow hygiene guidelines.

·    Avoid rubbing your eyes vigorously.

·    Treat dry eye disease appropriately.

When Should I See My Healthcare Provider? Seek evaluation if pain, redness, or blurred vision persists or worsens.

When Should I Go to the Emergency Room? Go immediately if you experience severe vision loss, penetrating injury, or chemical exposure.

What Questions Should I Ask My Healthcare Provider?

    ·    How large is my corneal abrasion?

    ·    Is there a risk of infection?

    ·    When can I resume contact lens use?

    ·    Do I need follow-up care?

    ·    How can I prevent recurrence?

Key Takeaways:

    ·    A corneal abrasion is a scratch on the corneal epithelium.

    ·    Even small abrasions can cause significant pain.

    ·    Most heal within one to three days.

    ·    Prompt treatment prevents infection.

    ·    Protective eyewear reduces risk.