Corneal Abrasion

Definition | Aetiology | Pathophysiology | Risk Factors | Signs and Symptoms | Investigations | Management | References

Definition

A corneal abrasion is a superficial scratch or injury to the cornea, the transparent front part of the eye that covers the iris, pupil, and anterior chamber.

Aetiology

Corneal abrasions can result from various causes, including:

• Foreign bodies (e.g., dust, sand, metal shavings)
• Trauma to the eye (e.g., fingernail scratch, contact lens misuse)
• Improper use of contact lenses
• Eye rubbing
• Chemical exposure
• Dry eyes
• Eyelid disorders (e.g., entropion)

Pathophysiology

The cornea is composed of several layers, including the epithelium, Bowman's layer, stroma, Descemet's membrane, and endothelium. A corneal abrasion typically involves damage to the epithelial layer, leading to pain, tearing, and potential risk of infection if not properly managed.

Risk Factors

• Contact lens wear
• Occupations or activities involving exposure to foreign bodies or chemicals
• Previous eye injuries
• Sports without proper eye protection
• Dry eye conditions

Signs and Symptoms

Common signs and symptoms of a corneal abrasion include:

• Severe eye pain
• Foreign body sensation
• Tearing
• Redness of the eye
• Blurred vision
• Light sensitivity (photophobia)
• Blepharospasm (involuntary tight closure of the eyelids)

Investigations

• Clinical history and physical examination
• Fluorescein staining of the cornea to identify the abrasion
• Slit-lamp examination to assess the extent and depth of the abrasion
• Eversion of the eyelid to check for retained foreign bodies

Management

Primary Care Management

• Fluorescein staining and examination: To confirm the presence and extent of the abrasion
• Topical antibiotics: To prevent infection (e.g., chloramphenicol ointment)
• Lubricating eye drops: To keep the eye moist and promote healing
• Pain management: Oral analgesics such as paracetamol or ibuprofen
• Immediate referral to emergency eye service: If any of the following conditions are met:
  • A suspected penetrating eye injury or intraocular foreign body is present
  • Significant orbital or peri-ocular trauma has occurred
  • A chemical injury has occurred
  • A retained foreign body that cannot be removed safely in primary care is present
  • Any of the following red flag clinical features are present:
    • Severe pain
    • Irregular, dilated or non-reactive pupils
    • Significant reduction in visual acuity
    • Hyphaema (blood in the anterior chamber) or hypopyon (pus in the anterior chamber)
    • Large or deep abrasions
    • Corneal opacity
    • Infection or corneal ulcer is suspected
    • They are unable to tolerate examination or foreign body removal in primary care
• Advise the person not to place pressure on the eye and to limit coughing or straining to prevent extrusion of intraocular contents.
• Do not remove foreign bodies that are visible and protruding out of the globe.
• Immediate irrigation of the eye with copious irrigation fluid (such as lactated Ringer's solution, normal saline, or water if other irrigation solutions are not available) for 20-30 minutes if a chemical injury has occurred, and refer as an emergency to ophthalmology.
• Have a low threshold for referral of young children who may not be able to explain symptoms or are reluctant to open their eye for examination.

Specialist Management

• Debridement: Removal of loose or damaged epithelial tissue to promote healing
• Bandage contact lens: To protect the cornea and provide pain relief in certain cases
• Topical cycloplegics: To reduce ciliary spasm and associated pain (e.g., cyclopentolate)
• Follow-up: Regular monitoring to ensure proper healing and to detect any complications such as infection or scarring
• Management of underlying conditions (e.g., dry eye) to prevent recurrence

References

1. NICE. (2024). Corneal Abrasion: Diagnosis and Management. Retrieved from NICE
2. NHS. (2023). Corneal Abrasion. Retrieved from NHS
3. British Medical Journal (BMJ). (2022). Corneal Abrasion: Diagnosis and Management. Retrieved from BMJ
4. American Academy of Ophthalmology (AAO). (2021). Clinical Practice Guidelines: Corneal Abrasion. Retrieved from AAO

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