Corneal Abrasions

Ovid: 5-Minute Sports Medicine Consult, The

Corneal Abrasions
Nilesh Shah
  • Removal or scraping away of the superficial layers of the cornea (stratified squamous epithelium) without penetration of Bowman's membrane.
  • In some cases, the bulbar conjunctiva is also involved.
  • In the general population, injury usually results from contact lens misuse but also can be attributed to foreign bodies, tangential shearing injuries, and contusion to the globe.
  • In the workplace, both physical trauma and chemical trauma may be an etiology for corneal abrasions.
  • In sports, the mechanism is more commonly direct trauma.
  • Severe corneal injuries also can involve the deeper, thicker stromal layer; in this situation, the term corneal ulcer may be used.
  • Most common eye injury after soft tissue injuries
  • More common in sports with projectiles/balls
  • More common in collision sports
Risk Factors
  • Collision/contact sports
  • Contact lens use, especially soft lenses
  • Failure to wear eye protection
  • Sports with projectiles/balls
General Prevention
Single-piece-construction protective eyewear with 3-mm polycarbonate lenses will reduce the risk of eye injuries.
Commonly Associated Conditions
  • Hyphema (blood in the anterior chamber)
  • Scleral rupture: Look for vitreous leak.
  • Intraocular foreign body
  • Rust ring
  • Perforation: Look for vitreous leak.
  • Orbital fracture
  • Iridodialysis: Defect of the iris caused by its separation from the scleral spur
  • Superinfection
  • Recurrent erosion syndrome
  • Mechanism of injury guides physical exam for associated injuries and delineates the need for further studies.
  • History of previous injuries: Possible viral keratitis or recurrent erosion syndrome
  • Contact lens history (hard, soft, overuse): Symptoms are usually better with contact in place, acting as a bandage.
  • Risk of foreign body: Particular sports, windy conditions, etc.
Physical Exam
  • Signs and symptoms include:
    • Pain
    • Redness
    • Lacrimation
    • Foreign-body sensation
    • Photophobia
    • Blepharospasm
  • Physical examination includes:
    • General bony orbital exam
    • Cranial nerve assessment
    • Ocular movements
    • Topical anesthetic and cycloplegic agents: May be needed to decrease pain and photophobia for optimal exam
    • Visual acuity
    • Loupe with good light or slit lamp (preferable)
    • Fluorescein drops/strips: Sharply demarcates defects in corneal epithelium and helps to differentiate from herpes keratitis (dendritic pattern)
    • Anterior chamber and corneal exam: Slit lamp preferred to rule out associated injuries (hyphema, perforation)
    • Eversion of upper and lower lids: Identify any foreign bodies under tarsal plate.
    • Intraocular pressure (IOP): Unless perforation/scleral rupture is suspected
Diagnostic Tests & Interpretation
  • Orbital series: Only if history or physical exam suggests fracture
  • US (B-scan)/CT scan/MRI: If occult intraocular foreign body is suspected
Differential Diagnosis
  • Foreign body
  • Corneal laceration
  • Perforation
  • Viral keratitis (usually herpes)
  • Conjunctivitis: Infectious/allergic
  • Iridocyclitis
  • Optic neuritis
  • Retinal detachment
  • Keratitis
  • Scleritis/episcleritis
  • Blepharitis
  • Keratoconjunctivitis
  • Canaliculitis
  • Globe injury
  • Orbital fracture
  • Photokeratitis/retinitis
  • Periorbital cellulitis
  • Trichiasis
  • Intraocular foreign body
Ongoing Care
Follow-Up Recommendations
  • Hyphema
  • Intraocular foreign body/rust ring
  • Perforation
  • Recurrent erosion syndrome
Patient Monitoring
  • Eye rest (ie, minimize reading or heavy computer work that requires substantial eye movement): This helps to minimize interference with reepithelialization.
  • Avoid light or wear sunglasses for comfort owing to photophobia.
Patient Education
  • Eye protection during the healing process is important, especially in patients whose jobs put them at increased risk of corneal abrasions or ultraviolet (UV) exposure.
  • If the patient is unconscious or cannot voluntarily close his or her eyelids (eg, Bell palsy or other neuropathies), eyelids may be taped closed and use of lubrication considered.
  • The prognosis is usually good, with healing and full recovery of vision if prompt evaluation and treatment are initiated.
  • Some deep abrasions heal with a scar. If this occurs in the central visual axis (the central area of the cornea directly over the pupil), visual acuity may be permanently lost. Deep abrasions within the central visual axis should be considered for ophthalmologic referral.
  • Healing of minor abrasions is expected within 24–48 hr. Extensive or deep abrasions may require a week to heal.
  • 370.00 Corneal ulcer, unspecified
  • 371.82 Corneal disorder due to contact lens
  • 918.1 Superficial injury of cornea
  • E91.4 Corneal foreign body
  • H16.0 Corneal ulcer, unspecified
  • H18.9 Corneal disorder, unspecified
  • H19.2 Corneal keratitis
  • H19.2 Herpes zoster keratoconjunctivitis
  • S05.0 Corneal abrasion

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