eMedicine Specialties > Ophthalmology > Cornea

Corneal Abrasion: Differential Diagnoses & Workup

Author: Arun Verma, MD, Senior Consultant, Department of Ophthalmology, Dr Daljit Singh Eye Hospital, India
Contributor Information and Disclosures

Updated: Nov 18, 2009

Differential Diagnoses

Blepharitis, Adult
Keratitis, Bacterial
Conjunctivitis, Bacterial
Keratoconjunctivitis, Sicca
Conjunctivitis, Viral
Keratopathy, Neurotrophic
Corneal Erosion, Recurrent
Laceration, Corneoscleral
Corneal Foreign Body
Trichiasis
Dry Eye Syndrome
Ulcer, Corneal
Dystrophy, Map-dot-fingerprint
Uveitis, Anterior, Granulomatous
Entropion
Uveitis, Anterior, Nongranulomatous
Glaucoma, Angle Closure, Acute
Herpes Simplex

Other Problems to Be Considered

Dendritic keratopathy: Corneal epithelial changes characterized by a branching pattern are referred to as dendriform or dendritic keratopathy. The foremost entity with a branching pattern is herpes simplex dendritic keratitis. Few other conditions create this pattern, but they should be considered in the differential diagnosis of healing epithelial abrasions. These conditions include dendritic plaques in herpes zoster ophthalmicus and the rare condition of dendriform keratopathy in tyrosinemia. In addition to creating complex dendritic and vortex patterns, healing corneal abrasions may have a simple linear pattern at the forefront of epithelial migration. Such lines are easy to diagnose on the basis of the history and their rapid evolution.

Conjunctiva and cornea: Diabetes affects the cornea by interfering with the hemidesmosomes that anchor the epithelium to its basement membrane. The number of hemidesmosomes in people with diabetes is markedly reduced, a phenomenon that may be due to altered extracellular matrix. As a consequence of this reduction, the epithelium is removed relatively easily, and minimal trauma can lead to corneal abrasions. Moreover, reepithelialization takes longer in people with diabetes than in those without diabetes, and these patients may develop recurrent erosion syndrome. This is a particular problem in patients undergoing vitrectomy because the entire epithelium may be removed at surgery for visualization, delaying healing.

Related conditions include a painful eye and tearing.

Workup

Laboratory Studies

  • If a corneal ulcer is suspected, consider ordering bacterial cultures before instilling antibiotics.

Procedures

  • Slit lamp examination 
    • Use of a topical anesthetic (eg, proparacaine, tetracaine) may facilitate the examination.
    • In cases of severe photophobia that causes blepharospasm, instillation of a cycloplegic agent (eg, Cyclogyl, homatropine) 20-30 minutes before the examination may be required.
    • Perform fluorescein instillation and examination with blue light. (Fluorescein can permanently stain soft contact lenses. Do not forget to remove such lenses before applying the stain.)

    • This corneal abrasion appears as a yellow-green a...

      This corneal abrasion appears as a yellow-green area when stained with fluorescein and viewed with a blue light.

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      This corneal abrasion appears as a yellow-green a...

      This corneal abrasion appears as a yellow-green area when stained with fluorescein and viewed with a blue light.

    • Examine the anterior chamber for evidence of iritis (cells and flare).
  • Evert the eyelid to look for blepharoconjunctival foreign bodies.

Histologic Findings

On histopathologic examination, intercellular and intracellular epithelial edema is associated with intraepithelial cysts, cellular debris, and intermittent pyknotic nuclei. Intraepithelial basement membrane formation may be present. Basement membrane under regenerating epithelium may appear thickened and multilaminar. Hemidesmosomes tend to be absent or form late in the course of epithelial healing.

Corneal abrasion and inflammation, paracentesis, intraocular infection, and uveal inflammation all cause a breakdown of the blood-aqueous barrier so that plasma proteins and inflammatory cells pour into the anterior chamber. As a result, inflamed aqueous humor has increased levels of serum proteins, including immunoglobulins and complement components C1-C7.

More on Corneal Abrasion

Overview: Corneal Abrasion
Differential Diagnoses & Workup: Corneal Abrasion
Treatment & Medication: Corneal Abrasion
Follow-up: Corneal Abrasion
Multimedia: Corneal Abrasion
References
Further Reading
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Further Reading

Guidelines

Eye. American College of Occupational and Environmental Medicine.
Eye. Work Loss Data Institute.

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Keywords

corneal abrasion, superficial corneal injuries, superficial corneal defects, epithelial defects, transient corneal erosions, ocular abrasion, ocular injuries, corneal ulcers, foreign body, corneal injury, scraped cornea, scratched cornea, eye scratch, something in the eye, foreign body sensation, eye pain, corneal epithelial defect, photophobia, keratitis

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Contributor Information and Disclosures

Author

Arun Verma, MD, Senior Consultant, Department of Ophthalmology, Dr Daljit Singh Eye Hospital, India
Disclosure: Nothing to disclose.

Medical Editor

Kilbourn Gordon III, MD, FACEP, Urgent Care Physician
Kilbourn Gordon III, MD, FACEP is a member of the following medical societies: American Academy of Ophthalmology and Wilderness Medical Society
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

Managing Editor

Christopher J Rapuano, MD, Professor, Department of Ophthalmology, Jefferson Medical College of Thomas Jefferson University; Co-Chairman of the Cornea Service, Co-Chairman of Refractive Surgery Department, Wills Eye Institute
Christopher J Rapuano, MD is a member of the following medical societies: American Academy of Ophthalmology, American Society of Cataract and Refractive Surgery, Contact Lens Association of Ophthalmologists, Cornea Society, Eye Bank Association of America, International Society of Refractive Surgery, and Pan-American Association of Ophthalmology
Disclosure: Allergan Honoraria Speaking and teaching; Allergan Consulting fee Consulting; Alcon Honoraria Speaking and teaching; Inspire Honoraria Speaking and teaching; RPS Ownership interest Other; Vistakon Honoraria Speaking and teaching

CME Editor

Lance L Brown, OD, MD, Ophthalmologist, Affiliated With Freeman Hospital and St John's Hospital, Regional Eye Center, Joplin, Missouri
Disclosure: Nothing to disclose.

Chief Editor

Hampton Roy Sr, MD, Associate Clinical Professor, Department of Ophthalmology, University of Arkansas for Medical Sciences
Hampton Roy Sr, MD is a member of the following medical societies: American Academy of Ophthalmology, American College of Surgeons, and Pan-American Association of Ophthalmology
Disclosure: Nothing to disclose.

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