Corneal Abrasion

Corneal Abrasion is superficial disruption of corneal epithelial surface, usually produced by trauma. Many corneal abrasions, are prevented due to inherent brisk protective reflexes, like closure of eyelids. Corneal abrasion is also prone to infection, like any other soft tissue injury. Corneal abrasions are more common among older children who wear contact lenses for visual improvement.

Cornea is important for normal vision. Scarring or corneal opacity may affect vision. Corneal abrasions may be prevented by wearing protective glasses, while performing activities which may put eyes at risk of injury.

 

References

Tasman William, Jaeger Edward A. The Wills Eye Hospital – Atlas of Clinical Ophthalmology Second Edition. Lippincott Williams & Wilkins 2001. P 39.

Wolfson Allan B. Harwood – Nuss’ Clinical Practice of Emergency Medicine Fifth Edition. Lippincott Williams & Wilkins, a Wolters Kluwer Business 2010. P 349- 351.

Mick Nathan W, Peters Jessica R, Egan Daniel, Nadel Eric S, Walls Ron, Silvers scott. Blueprints Emergency Medicine Second Edition. Lippincott Williams & Wilkins 2006. P 248- 249.

Baren Jill M, Rothrock Steven G, Brown Lance. Pediatric Emergency Medicine. Saunders, an imprint of Elsevier Inc. 2008. P 161.

Mandavia Diku P, Newton Edward J, Demetriades Demetrios. Color Atlas of Emergency Trauma. Cambridge University Press 2003. P 36.

Ferri Fred F. 2015 Ferri’s Clinical Advisor- 5 Books in 1. Mosby, an imprint of Elsevier Inc. 2015. P 326.

Kaiser Peter K, Friedman Neil J, Pineda Roberto. The Massachusetts Eye and Ear Infirmary Illustrated Manual of Ophthalmology Fourth Edition. Elsevier Saunders 2014. P 173- 174. 

 Basak Samar K. Jaypee Gold Standard Mini Atlas Series- Diseases of the Cornea. Jaypee Brothers Medical Publishers 2011. P 248- 249.   

Dadapeer K. Clinical methods in Ophthalmology- Practical Manual for Undergraduates. Jaypee Brothers Medical Publishers 2013. P 181.

https://emedicine.medscape.com/article/1195402-overview

https://www.aao.org/eye-health/diseases/what-is-corneal-abrasion

 

Symptoms of corneal abrasion include

  • Pain
  • Sensitivity to light (Photophobia)
  • Watering
  • Foreign body sensation
  • Redness
  • Blurring of vision
  • Swelling of eyelids

 

Causes include

  • Trauma is a common cause, including injury by nail.
  • Use of contact lenses
  • Foreign body
  • Chemical injury
  • Thermal injury

 

Diagnosis depends upon clinical examination under slit- lamp. Examination may also be conducted using a portable source of ultra-violet light such as Wood’s lamp.

Small abrasions may be missed in certain cases, which require further evaluation after staining with fluorescein sodium dye. After fluorescein staining of eye, corneal abrasion appears yellow under normal light and green in cobalt blue light.

Multiple vertically arranged linear markings of abrasion on cornea may be due to retained foreign body in sulcus subtarsalis of upper eyelid. It scratches corneal surface due to unavoidable blink reflex of upper eyelid.

Corneal stromal oedema may be seen with severe or long lasting abrasions.

 

Differential diagnosis

Corneal abrasions may be differentiated from conditions such as

  • Viral keratitis including Herpes infections.
  • Foreign body in cornea
  • Infective keratitis
  • Conjunctival infection
  • Recurrent corneal erosion syndrome in cases with multiple episodes of corneal abrasions.
  • Corneal dystrophies or degenerations like epithelial basement dystrophy may produce recurrent corneal abrasions.
  • Scleritis
  • Acute angle closure glaucoma.
  • Anterior uveitis

 

 

Management includes

Medical therapy

  • Antibiotic eye drops and eye ointments may be used to prevent secondary infection. Anti-pseudomonal topical antibiotics are recommended for contact lens related corneal abrasions.
  • Lubricating agents like methylcellulose eye drops.
  • Cycloplegic eye drops like tropicamide or homatropine may be used to relieve pain due to ciliary spasm.
  • Bandage contact lenses may help to speed up healing in cases with large epithelial abrasions.

Closing eyelid with patching of eye is no longer recommended because it may produce decreased oxygen delivery, increased moisture and increased risk of infection.

Surgical therapy

Corneal abrasion patients with lagophthalmos, who are not improving may require tarsorrhaphy.

  • PUBLISHED DATE : Oct 22, 2018
  • PUBLISHED BY : NHP Admin
  • CREATED / VALIDATED BY : Dr. S. C. Gupta
  • LAST UPDATED ON : Oct 22, 2018

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