Corneal Abrasions

Corneal abrasions are scratches or damage to the cornea. They are a cause of red, painful eye. There are some common causes:

  • Contact lenses
  • Foreign bodies
  • Fingernails
  • Eyelashes
  • Entropion (inward turning eyelid)

 

If the abrasion is associated with the use of contact lenses there may be infection with pseudomonas.

An important differential diagnosis to consider is herpes keratitis as this will require treatment with antiviral eye drops.

Chemical abrasions (e.g., from acid) can cause severe damage to the eye and loss of vision.

 

Presentation

  • History of contact lenses or foreign body
  • Painful red eye
  • Foreign body sensation
  • Watering eye
  • Blurring vision
  • Photophobia

Diagnosis

A fluorescein stain is applied to the eye to diagnose a corneal abrasion. This is a yellow-orange colour. The stain collects in abrasions or ulcers, highlighting them.

Slit lamp examination may be used in more significant abrasions.

 

Management

NICE Clinical Knowledge Summaries on red-eye say patients with potentially sight-threatening causes of red eye should be referred for same-day assessment by an ophthalmologist. Mild, uncomplicated abrasions may be managed in primary care where there is appropriate experience and skill.

Management options include:

  • Removing foreign bodies
  • Simple analgesia (e.g. paracetamol)
  • Lubricating eye drops
  • Antibiotic eye drops (i.e. chloramphenicol)
  • Follow-up after 24 hours

 

Cyclopentolate eye drops dilate the pupil (they are mydriatics – causing mydriasis, meaning pupil dilation). They may be considered to help relieve symptoms, although evidence is lacking for their use in uncomplicated abrasions.

Chemical abrasions require immediate irrigation for 20-30 minutes and urgent referral to ophthalmology.

Uncomplicated corneal abrasions usually heal over 2-3 days.

 

Last updated April 2019