Module 8.1 - Corneal Abrasion

Question 1

What is a corneal abrasion?

Answer 1

A scratch or scrape on the cornea, which is the clear, round dome covering the eye’s iris and pupil.

Question 2

What are 2 causes of a corneal abrasion?

Answer 2

1. Usually associated with chemical, burn or mechanical trauma (including foreign body)
2. Result of outdoor activity, occupational hazards and lack of using proper eye protection (e.g. welding, painting, and construction).

Question 3

What are the subjective/physical exam findings associated with a corneal abrasion?

Answer 3

A. Intense pain due to extensive sensory nerve supply to the eye.

B. A sense of foreign body in the eye

C. Report of redness or discharge of the conjunctiva

D. May or may not have a complaint off decreased visual acuity

E. Complaint of tearing.

F. Photophobia

G. Decrease in visual acuity:

• Except in trauma involving the emergency need for irrigation of the eye, visual acuity should be the initial measure of vision, using either the Snellen chart or, if unavailable, performing a gross examination, such as a finger count.
• Instill a topical anesthetic, such as tetracaine (Pontocaine) ophthalmic drops (1-2) drops. Note* Avoid repeated use of anesthetic drops, which may result in further injury and delayed healing.

H. Inspect for other signs of trauma (foreign body) by everting the lid - Refer to conjunctivitis notes for lid eversion procedure.

Question 4

When and why is Fluorescein staining of the cornea done?

Answer 4

• Best test to evaluate for corneal abrasion
• May reveal disruptions in the corneal epithelium; appears as increased uptake (pooling) of dye when the area is illuminated by a Wood lamp or ultraviolet (blue) light.

Question 5

How do you manage a corneal abrasion?

Answer 5

1. Apply antibiotic ointment or solution, such as the following:

• Gentamycin ophthalmic ointment 0.3% ½ inch ribbon to affected eye 2-3 times daily, or solution 3mg/ml, 1-2 drops into affected eye every 2-3 hours while awake, or
• Sulfacetamide sodium, 1-% ointment, apply a ½ inch ribbon to affected eye every 3-8 hours for 7-10 days, or solution, apply 1-2 drops every 2-6 hours.
• Cycloplegic or mydriatic drops (e.g. isopto atropine [Atropisol], isopto, and tropicamide [Mydriacyl] may be prescribed for 24 hours (until recheck by clinician) to promote analgesia and healing. Caution regarding glaucoma: Adverse effect of ciliary and papillary dilatation is increased ocular pressure. Do not use in a patient with closed angle glaucoma.

2. Apply a soft eye patch; dressing should be removed within 24 hours by the clinician.
3. Update tetanus immunization if indicated
4. Reevaluate in 24 hours, at which time healing should be complete.

5. Refer to an ophthalmologist for removal of foreign bodies or for failed initial management.