Gadzooks, Corneal Abrasion Hurts!

Corneal abrasions require prompt medical attention

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I had a relative who scratched his cornea. He would sleep with his eyes open. No thread count could smooth the course of that painful voyage. It happens.

Or how about this situation? Your kid gets sand in her eye at the playground. Bam, corneal abrasion! Like I said, it happens.

What is a Corneal Abrasion?

Trauma to the eye can cause corneal abrasion. After the abrasion, the cornea swells or inflames.

Your eye is the nerve-laden outermost extension of the central nervous system; exquisite pain results from injury to the eye. Although the prevalence of corneal abrasion is unknown, an estimated 85 percent of all closed-eye injuries presenting to the emergency room are attributable to this injury.

Remember that the cornea covers the iris, pupils, and anterior chamber. The cornea both protects the eye and refracts light onto the retina so you can see. Please do your best to protect your cornea. Not everybody is lucky enough to sport a healthy cornea, and each year ophthalmologists or eye surgeons perform an estimated 33,000 transplants to replace diseased or injured corneas.

Symptoms of corneal abrasion include the following:

  • pain
  • tearing
  • photophobia
  • redness
  • foreign body sensation

Diagnosis of Corneal Abrasion

Trauma accounts for most, but not all, cases of corneal abrasion. Here are some risk factors:

  • occupations including metal workers, construction workers, landscapers and miners carry increased risk of eye injury from foreign bodies;
  • sports such as racquetball, lacrosse or hockey can result in ocular trauma and corneal abrasion;
  • ventilated neonates and sedated adults may scratch their corneas on equipment such as masks;
  • use of contact lenses (do you sleep in your contacts?);
  • exposure to windblown particulate matter;
  • herpes infection affecting the eye or mouth.

When diagnosing corneal abrasion, an emergency room or primary care physician will (fluorescin) stain the cornea under a special light. Moreover, a slit lamp is used to determine whether a foreign body penetrated the cornea. In case a foreign body has rended its way through the cornea, special forms of visualization (available to an ophthalmologist) are used. Interestingly, CT can also be used to detect a foreign body made of metals and some non-metals and lodged in the eye.

Sometimes, injury can result in infection. In these cases, your physician will take a culture and send it off to the lab.

Treatment of Corneal Abrasion

Here's how a corneal abrasion is treated:

  • If present, contact lenses are removed, and you should absolutely avoid wearing your contacts until the injury heals.
  • Non-penetrating bodies are removed or referred for removal. A topical anesthetic like proparacaine or tetracaine is first applied to dull the pain. Then, irrigation with sterile saline, wet-tip cotton applicator or fine-tip needle is used.
  • NSAIDS like aspirin or ibuprofen are given for pain and inflammation. Topical antibiotics are usually given, too, like erythromycin ointment. Interestingly, although chloramphenicol isn't used for corneal injury in the United States, it is used in other countries, and researchers suggest that chloramphenicol may deter formation of a post-injury ulcer.
  • In case of a penetrating injury, you should see an eye surgeon for removal of the foreign body.  Typically, corneal lacerations or cuts aren't patched if their length is fewer than 10 mm. However, more extensive damage may require surgery.

Fortunately, cornea abrasions resolve after a few days. However, if pain, redness, and photophobia persist, there's a good chance that even after initial examination, a foreign body may still reside in your eye. With corneal injuries, act quickly to see a physician and never hesitate to see or request to see an ophthalmologist. Postponing care may result in permanent vision loss!

Finally, the best way to treat a scratched cornea is to avoid one in the first place--always wear protective eye wear when cutting wood, working with metal and so forth. And, of course, advise your kids to refrain from throwing sand and dirt at the playground. Oh, and please don't ever sleep in your contacts, even if they are labeled "extended wear." Sleeping in your contacts is poor hygiene and runs the risk of corneal abrasion or infection.

Selected Sources

Mayer TA, Fullerton K, Bosley B. Chapter 115. Eye Problems in Infants and Children. In: Tintinalli's Emergency Medicine: A Comprehensive Study Guide, 7e. New York, NY: McGraw-Hill; 2011. Accessed February 08, 2015.

Usatine RP, Smith MA, Chumley HS, Mayeaux EJ, Jr.. Chapter 15. Corneal Foreign Body and Corneal Abrasion. In: The Color Atlas of Family Medicine, 2e. New York, NY: McGraw-Hill; 2013. . Accessed February 08, 2015.

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