Corneal Abrasion Differential Diagnoses

  • Author: Arun Verma, MD; Chief Editor: Hampton Roy Sr, MD   more...
 
Updated: Aug 3, 2011
 
 

Diagnostic Considerations

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.

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, 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.

Differential Diagnoses

Proceed to Workup
 
 
Contributor Information and Disclosures
Author

Arun Verma, MD  Senior Consultant, Department of Ophthalmology, Dr Daljit Singh Eye Hospital, India

Disclosure: Nothing to disclose.

Coauthor(s)

Feras H Khan, MD  Clinical Fellow, Critical Care Medicine, Stanford University Hospital

Feras H Khan, MD is a member of the following medical societies: Society for Academic Emergency Medicine and Society of Critical Care Medicine (USA)

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.

Additional Contributors

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.

Christopher J Rapuano, MD Professor, Department of Ophthalmology, Jefferson Medical College of Thomas Jefferson University; Director of the Cornea Service, Co-Director 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; EyeGate Pharma Consulting; Inspire Consulting fee Consulting; Bausch & Lomb Honoraria Speaking and teaching; Bausch & Lomb Consulting fee Consulting

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

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This corneal abrasion appears as a yellow-green area when stained with fluorescein and viewed with a blue light.
Corneal abrasion.
Corneal abrasion.
Corneal keratitis and staining.
Corneal foreign body.
Corneal foreign body after removal.
Corneal foreign body with cobalt blue lighting showing abrasion.
 
 
 
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