Corneal abrasion
Background
- Must rule-out intraocular foreign body and corneal laceration
Clinical Features
- Foreign body sensation
- Photophobia (+/- consensual)
- Decreased vision
- If associated iritis or if abrasion occurs in visual axis
- Eye pain
- Relief of pain with topical anesthesia
- Virtually diagnostic of corneal abrasion
- Relief of pain with topical anesthesia
Corneal Abrasions from Airbag Deployment
Corneal Abrasions from Airbag Deployment
Differential Diagnosis
Unilateral red eye
- Acute angle-closure glaucoma^
- Anterior uveitis
- Conjunctivitis
- Corneal erosion
- Corneal ulcer^
- Endophthalmitis^
- Episcleritis
- Herpes zoster ophthalmicus
- Inflamed pinguecula
- Inflamed pterygium
- Keratoconjunctivitis
- Keratoconus
- Nontraumatic iritis
- Scleritis^
- Subconjunctival hemorrhage
- Orbital trauma
^Emergent diagnoses
^^Critical diagnoses
Evaluation
- A complete eye exam should be conducted
- Eyelid Exam
- Flip upper lid and exam lower lid for foreign body
- If concern for foreign body despite normal exam, consider orbital CT or MRI if certain foreign body is nonmetallic
- Fluorescein Exam
- Apply 1 gtt of flourescein or use strip with anesthetic
- Use Wood's lamp or slit lamp with cobalt blue light
- Fluorescein will fill corneal defects and glow
- Multiple vertical abrasions suggests foreign body embedded under the upper lid
Additional Considerations
- Contact lens wearer
- If white spot or opacity on exam concerning for infiltrate or ulceration refer for same day ophtho appt
- Fluorescein Examination
- Seidel sign (streaming of fluorescein) indicates penetrating trauma
- Branching/Dendritic pattern suggests possible Herpes Zoster Ophthalmicus
- Visual acuity
- If poor, consider corneal edema versus infectious infiltrate
- Pupil shape and reactivity
- Irregular or nonreactive pupil suggests pupillary sphincter injury and possible penetrating trauma
- Hyphema or hypopyon
- Hyphema suggests possible penetrating injury
- If present then same same-day ophtho consult is required
- Extruded ocular contents
- If yes then place eye shield and obtain emergent ophtho referral
- Corneal Ulcer
- Grayish white lesion
- Worsening symptoms >1day
Management
Antibiotics
Does Not Wear Contact Lens
- Erythromycin ointment qid x 3-5d OR
- Ciprofloxacin 0.3% ophthalmic solution 2 drops q6 hours OR
- Ofloxacin 0.3% solution 2 drops q6 hours OR
- Sulfacetamide 10% ophthalmic ointment q6 hours
Wears Contact Lens
Antibiotics should cover pseudomonas and favor 3rd or 4th generation fluoroquinolones
- Levofloxacin 0.5% solution 2 drops ever 2 hours for 2 days THEN q6hrs for 5 days OR
- Moxifloxacin 0.5% solution 2 drops every 2 hours for 2 days THEN q6hrs for 5 days OR
- Tobramycin 0.3% solution 2 drops q6hrs for 5 days OR
- Gatifloxacin 0.5% solution 2 drops every 2 hours for 2 days THEN q6hrs for 5 days OR
- Gentamicin 0.3% solution 2 drops six times for 5 days
Analgesia
- Systemic NSAIDs or opioids
- Cycloplegics can be consider for patients with large abrasions (>2mm) and/or severe pain
- Cyclopentolate 1% 1 drop q6-8hr
- Ophthalmic NSAIDs
- Ketorolac 0.4% 1 drop q6hr x 2-3d
- Topical anesthetics
- Tetracaine 1% 1 drop q30min has been found to be safe in the first 24 hrs[1]
Other
- Tetanus prophylaxis not indicated (unless penetrating injury)[2]
- Patch is not routinely recommended[3] and can prolong healing time[4]
Disposition
- Ophtho follow up in 48h for routine cases
- Minor abrasions will heal in 48-72h
References
- Waldman N, et al. Topical tetracaine used for 24 hours is safe and rated highly effective by patients for the treatment of pain caused by corneal abrasions: a double-blind, randomized clinical trial. Acad Emerg Med. 2014; 21(4):374-82.
- Mukherjee P, et al. Tetanus prophylaxis in superficial corneal abrasions. Emerg Med J. 2003; 20:62-64.
- Flynn CA, et al. Should we patch corneal abrasions? A meta-analysis. J Fam Pract. 1998; 47(4):264-70.
- Fraser, S. Corneal abrasion. Clin Ophthalmol. 2010; 4:387-390.
See Also
This article is issued from
Wikem.
The text is licensed under Creative
Commons - Attribution - Sharealike.
Additional terms may apply for the media files.