SIGNS AND SYMPTOMS 
- Severe ocular pain
- Gritty (scratchy) discomfort
- Tearing
- Blepharospasm
- Foreign body sensation
- Photophobia (particularly if secondary traumatic iritis present)
- Conjunctival injection
- Diminished or blurred vision
- Headache
History
- Any direct trauma to the globe
- Any known or potential foreign body
- Contact lens use
- Any history of previous corneal abrasion
- Ocular/periocular surgery
- Pre-existing visual impairment
- Time of onset
- Associated symptoms or concomitant injury
- Treatment before visit
- Use of safety glasses (pounding, drilling, grinding metal) or eyeglasses
- Systemic disease (diabetes, autoimmune disorders)
- Tetanus status
Pediatric Considerations
- Signs and symptoms may differ:
- Younger than 12 mo:
- Frequently no history of eye trauma
- Might present as the crying inconsolable infant
- In 1–12 wk old may be an incidental finding and not the cause of their irritability or crying
- Older than 12 mo:
- More often will have history of minor eye trauma
- Positive eye signs
Physical Exam
- If indicated, evaluate for other life-threatening injuries with attention to the primary survey.
- Complete eye exam:
- Focus is to evaluate for evidence of penetrating injury and/or infection
- Gross visual inspection
- Visual acuity
- Penlight exam to evaluate for conjunctival injection, the pupil shape/reactivity, and for any evidence of corneal infiltrate or opacity
- Evert upper lids to check for retained foreign body
- Slit-lamp exam to evaluate for anterior chamber reaction, infiltrate, corneal laceration, and penetrating trauma
- Fluorescein dye to identify size and location of corneal epithelium defect
DIAGNOSIS TESTS & INTERPRETATION
Pediatric Considerations
Handheld slit-lamp and Wood lamp: Helpful in exam of pediatric eye
DIFFERENTIAL DIAGNOSIS
- Conjunctivitis, viral, or bacterial
- Corneal ulcer
- Glaucoma
- Herpes zoster
- Keratitis, viral or bacterial, or ultraviolet induced
- Recurrent corneal erosion syndrome
- Uveitis
- More extensive pathology than corneal abrasion:
- Laceration of cornea
- Perforation of cornea
- Hyphema
- Iris prolapse
- Lens disruption
[Outline]
INITIAL STABILIZATION/THERAPY
Instill topical anesthetic (proparacaine/tetracaine).
ED TREATMENT/PROCEDURES
- Removal of superficial foreign body:
- A residual rust ring does not need emergent removal. It can be removed at 24–48 hr
- Oral pain control:
- Topical pain control:
- Studies have demonstrated efficacy; however, there are scattered reports of adverse effects
- Avoid in patients with other ocular surface disease and in postoperative patient
- Topical diclofenac or ketorolac
- Cycloplegic (optional):
- Topical antibiotic:
- This practice has not been rigorously studied.
- Concern is for superinfection
- Ointment better than drops because also a lubricant
- Discontinue antibiotics once symptom free for 24 hr
- Contact lens wearers must have anti-Pseudomonal coverage:
- Eye patch:
- Does not appear to improve healing or reduce pain particularly in the 1st 24 hr
- Not recommended for small abrasions
- Never patch the patient who wears contact lens
- Never patch infection-prone injury (organic matter is at high risk)
- More research needed to evaluate efficacy of patching in abrasions > 10 mm
- Contact lens
- No contact lens wear till abrasion healed and eye feels normal for a wk without medication
- Might consider bandage contact lens in severe pain. Be certain no infection and will need daily follow-up
- Tetanus prophylaxis:
- Routine tetanus not necessary
- Update tetanus if abrasion caused by or contaminated with organic matter or dirt
- Emergent ophthalmologic consultation required for retained intraocular foreign body, penetrating injury to globe (or other more serious injury) and any patient with a corneal infiltrate, white spot, or opacity
MEDICATION
- Ciprofloxacin: 0.35% 1 drop QID
- Cyclopentolate: 0.5%, 1%, or 2% drops (mydriasis 1 or 2 drops TID)
- Diclofenac: 0.1% drops 1 drop QID
- Erythromycin: 0.5% ointment QID
- Gentamicin: 0.3% ointment QID
- Gentamicin: 0.3% 2 drops q6h
- Homatropine: 5% solution 2 drops BID
- Ketorolac: 0.5% drops 1 drop QID
- Proparacaine: 0.5% 1 drop once
- Sulfacetamide: 10% drops 2 drops QID
- Sulfacetamide: 10% ointment QID
- Tobradex: Suspension 0.1%/0.3% 2 drops q4–6h
- Tobramycin: 0.3% drops 2 drops q6h
- Tobramycin: 0.3% ointment q6h
- Tropicamide: 0.5%, 1% drops (mydriasis 6 hr) 1 drop q4h
[Outline]
DISPOSITION
Admission Criteria
Associated injuries requiring admission
Discharge Criteria
All simple corneal abrasions
Issues for Referral
No studies on optimal follow-up. Practice recommendations however dictate all corneal abrasions require follow-up to ensure healing without infection or scarring.
FOLLOW-UP RECOMMENDATIONS
- Follow-up with ophthalmologist for re-exam and ongoing care in 24 hr if in contact lens wearer, the eye has been patched or bandage contact lens applied
- Follow-up with ophthalmologist if central or large abrasion in 24 hr; otherwise follow-up can be in 48–72 hr
[Outline]
ICD9
918.1 Superficial injury of cornea
ICD10
- S05.00XA Inj conjunctiva and corneal abrasion w/o fb, unsp eye, init
- S05.01XA Inj conjunctiva and corneal abrasion w/o fb, right eye, init
- S05.02XA Inj conjunctiva and corneal abrasion w/o fb, left eye, init
[Outline]
- Calder LA, Balasubramanian S, Fergusson D. Topical nonsteroidal anti-inflammatory drugs for corneal abrasions: Meta-analysis of randomized trials. Acad Emerg Med. 2005;12:467–473.
- Ehlers JP, Shah CP, eds. The Wills Eye Manual. 5th ed. Baltimore, MD: Lippincott Williams and Wilkins; 2008.
- Jacobs DS. (2012). Corneal abrasions and corneal foreign bodies. Retrieved from www.uptodate.com
- Koenig KL. (2010). Dilute proparacaine for pain from corneal abrasion. Retrieved from Journal Watch Specialties (online).
- Turner A, Rabiu M. (2009). Patching for corneal abrasion. Retrieved from Cochrane Database Syst Rev.
- Van Niel CW. (2010). Corneal abrasions in crying infants: A red herring. Retrieved from Journal Watch Specialties (online).
- Verma A. (2011). Corneal abrasion. Retrieved from www.emedicine.com
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