Makindo Medical Notes.com

Corneal Abrasion

A corneal abrasion is a scratch or injury to the cornea, the clear, protective outer layer of the eye. This condition is usually caused by trauma, foreign bodies, or improper contact lens use.

Causes of Corneal Abrasion

• Trauma:
  • Accidental injury from fingernails, makeup brushes, or other objects.
  • Blunt trauma to the eye.
• Foreign Bodies:
  • Dust, sand, metal particles, or other small objects getting into the eye.
• Contact Lenses:
  • Improper use or care of contact lenses, such as wearing them for too long or not cleaning them properly.
• Dry Eyes:
  • Severe dryness causing the cornea to become more susceptible to abrasions.
• Eye Surgery:
  • Post-surgical complications or accidental injury during surgery.

Symptoms of Corneal Abrasion

• Severe pain and a gritty or foreign body sensation in the eye.
• Redness and tearing.
• Increased sensitivity to light (photophobia).
• Blurred vision or decreased visual acuity.
• Difficulty opening the eye due to pain.

Diagnosis: History Taking and Clinical Examination

• Detailed history to identify potential causes and associated symptoms.
• Ask what material the foreign body likely consists of, e.g. dirt, glass, metal or organic the mechanism of impact (hitting metal on metal is highly likely to cause a penetrating injury, whereas grinding or welding rarely do so)
• Exclude a penetrating eye injury as any penetration of the cornea or retained foreign body requires an urgent referral to an ophthalmologist for immediate consultation by phone.
• Discuss with senior staff if the foreign body is centrally located on the cornea (over the visual axis).

Comprehensive eye examination by an ophthalmologist or optometrist.

• Visual acuity: if not 6/6 then check with a pinhole.
• Slit lamp: assess for the size, site/s and nature of foreign body and the depth of penetration.
• Examine the cornea, anterior chamber, iris, pupil and lens for any distortion that may indicate ocular penetration and require urgent referral to an ophthalmologist.
• Evert the eyelids to exclude retained subtarsal foreign bodies and remove them if appropriate.
• Use fluorescein to exclude Seidel-positive corneal perforation and measure the size of the epithelial defect.

Treatment Options for Corneal Abrasion

• Medications:
  • Lubricating eye drops or ointments to keep the eye moist and reduce discomfort.
  • Antibiotic eye drops or ointments to prevent infection.
  • Pain relief medications such as oral analgesics or topical NSAIDs.
• Protective Measures:
  • Using an eye patch in some cases to keep the eye closed and facilitate healing.
  • Wearing sunglasses to reduce light sensitivity and protect the eye from further injury.
• Follow-up Care:
  • Regular follow-up visits to monitor healing and check for complications.

Complications of Untreated Corneal Abrasion

• Corneal infection or ulcer, leading to more severe damage and vision loss.
• Scarring of the cornea, causing permanent vision impairment.
• Chronic dry eye or recurrent corneal erosions.

Prevention and Management

• Wearing protective eyewear during activities that could result in eye injury.
• Proper use and care of contact lenses, following guidelines for cleaning and wear time.
• Avoiding rubbing the eyes, especially when there is a sensation of a foreign body.
• Using lubricating eye drops if prone to dry eyes, especially in dry or windy environments.

Summary

Corneal abrasions are injuries to the cornea that can cause significant discomfort and potential complications if left untreated. Early diagnosis and appropriate treatment are crucial to prevent infection, scarring, and vision loss. Preventive measures, such as wearing protective eyewear and proper contact lens care, can help reduce the risk of corneal abrasions.