Corneal Abrasion

 

👁️‍🗨️ Corneal Abrasion

🔍 Definition

A corneal abrasion is a loss of the superficial epithelial layer of the cornea, usually due to trauma, resulting in intense discomfort, tearing, and photophobia.

🧠 Although typically minor, if untreated or mismanaged, it can lead to infection or even corneal ulceration.

 

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🧨 Causes

Type	Examples
Mechanical trauma	Fingernail scratch, foreign body, contact lens
Chemical trauma	Mild chemical irritants (alkali/acid splash)
Iatrogenic	Post-surgery, diagnostic procedures
Contact lens misuse	Overwear or poor hygiene
Foreign body	Sand, metal, dust
Spontaneous	In recurrent erosion syndrome (e.g., EBMD)

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🧪 Symptoms

• ⚡ Sudden onset eye pain

• 😢 Excessive tearing (epiphora)

• 🌞 Photophobia

• 👀 Foreign body sensation

• 👓 Blurred vision

• 🩸 Mild redness (conjunctival injection)

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🔬 Signs on Examination

Test	Finding
Visual inspection	May show lid swelling, mild injection
Fluorescein staining	Reveals bright green area of abrasion under cobalt blue light
Eversion of eyelid	To check for retained foreign body
No discharge	Unlike conjunctivitis
Normal pupillary response	No afferent pupillary defect

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❗ Red Flags (indicate more serious pathology)

• Large or central abrasion

• Corneal infiltrate (suggests infection)

• Contact lens wearer (risk of Pseudomonas infection)

• Recurrent episodes (may suggest EBMD)

• Persistent epithelial defect >48 hours

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💊 Treatment

✅ General Management

Action	Notes
Topical antibiotic drops	Prevent secondary infection – e.g., erythromycin or ciprofloxacin (for contact lens users)
Lubricating drops or gels	Promote healing and reduce discomfort
Oral analgesics	NSAIDs for pain
Cycloplegics (optional)	If significant photophobia or ciliary spasm
Eye patching	❌ Generally not recommended anymore – slows healing
Avoid contact lenses	Until fully healed and cleared by clinician

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⚠️ Contact Lens Wearers

• Always use anti-pseudomonal coverage (e.g., ciprofloxacin or tobramycin drops)

• Higher risk of corneal ulcer and should be followed closely

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🔄 Healing & Follow-Up

• Most abrasions heal within 24–72 hours

• Re-evaluate if symptoms persist >48 hours

• Watch for signs of keratitis, especially in contact lens users

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👁️‍🗨️ Complications

• Recurrent Corneal Erosion Syndrome (RCES)

• Corneal ulcer (if infected)

• Corneal scarring (rare in small abrasions)

• Secondary infection

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👨‍⚕️ Prevention Tips

• Protective eyewear during activities like sports, welding, or construction

• Proper contact lens hygiene

• Avoid eye rubbing

• Prompt removal of foreign bodies

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🧠 Quick Mnemonic: "PAIN-E"

• Photophobia

• Abrasion visible with fluorescein

• Injury history or foreign body

• No vision loss (unless severe)

• Erythromycin drops (or appropriate antibiotic)

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Would you like:

• A visual diagram of corneal staining?

• A decision tree for red eye causes?

• Case-based examples for exam prep?