Corneal abrasion

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

• Acute angle-closure glaucoma^
• Anterior uveitis
• Caustic keratoconjunctivitis^^
• Conjunctival laceration
• Conjunctivitis
• Corneal abrasion
• Corneal erosion
• Ocular foreign body
• Corneal ulcer^
• Endophthalmitis^
• Episcleritis
• Globe rupture^
• Herpes zoster ophthalmicus
• Intraocular foreign body
• Inflamed pingueculum
• Inflamed Pterygium
• Keratoconjunctivitis
• Keratoconus
• Lens dislocation
• Nontraumatic iritis
• Scleritis^
• Subconjunctival hemorrhage
• Traumatic hyphema
• Traumatic iritis
• Ultraviolet keratitis

^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
  • Seidel sign (streaming of fluorescein) indicates penetrating trauma
  • Branching/Dendritic pattern suggests possible Herpes Zoster Ophthalmicus
• 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

• Erythromycin ointment qid x 3-5d OR
• Ciprofloxacin 0.3% ophthalmic solution 2 drops q6 hours
• Ofloxacin 0.3% solution 2 drops q6 hours
• Sulfacetamide 10% ophthalmic ointment q6 hours

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
  • Cyclopentolate 1% 1 drop q6-8hr
• Ophthalmic NSAIDs
  • Ketorolac 0.4% 1 drop q6hr x 2-3d
• Topical anesthetics
  • Tetracaine 1% 1 drop q30min has been found to be safe in the first 24 hrs

Other

• Tetanus prophylaxis not indicated (unless penetrating injury)
• Patch is not routinely recommended and can prolong healing time

Disposition

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

See Also

• Eye Algorithms (Main)

Authors

Ross Donaldson