eMedicine Specialties > Ophthalmology > Cornea

Corneal Abrasion: Follow-up

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

Updated: Nov 18, 2009

Follow-up

Further Outpatient Care

  • Patients with any corneal abrasions should receive follow-up care, especially until the fluorescein stain is negative, to determine if a corneal ulcer has developed.
  • Minor abrasions should heal within 24-48 hours and do not require follow-up if the patient is completely asymptomatic at 48 hours. Reexamine large abrasions frequently until reepithelialization occurs and the potential for infection no longer exists.
  • Advise eye rest (ie, no reading or work that requires substantial eye movement that might interfere with reepithelialization).
  • Advise patients to avoid light or to wear sunglasses for comfort if they have notable photophobia.

Inpatient & Outpatient Medications

  • Antibiotics should be continued until the patient is asymptomatic.
  • Narcotic analgesics (eg, oxycodone, hydrocodone) are often needed to treat severe pain until it can be managed with over-the-counter analgesics.
  • Twice-daily cycloplegics may be required to treat large abrasions until their healing is nearly complete.

Deterrence/Prevention

  • People must be educated to protect their eyes during activities and work, especially if they are at jobs that increase the risk of corneal abrasion or UV exposure or when hiking through areas of tall foliage (as during farming), for example.
  • If patients are unconscious or if they cannot voluntarily close their eyelids (eg, because of Bell palsy or other neuropathies), tape their eyelids closed.

Complications

  • If left untreated, corneal abrasions can lead to blinding corneal ulcers.
  • Because of shearing injury (eg, due to a fingernail or mascara brush), recurrent epithelial erosion sometimes occurs days to weeks after an abrasion heals.
    • These erosions may be caused by damage to the basement membrane (to which the newly healed overlying cells do not adhere well) and subsequent sloughing due to mild hypoxia that occurs during sleep.
    • Patients are typically awakened in the early morning by the same symptoms as those of a corneal abrasion.
    • Ophthalmologic follow-up care and observation are indicated.
  • Corneal ulcerations due to infection are more common after contact lens–related abrasions than after those due to other causes.
  • Ocular tetanus is rare.
  • Allergic conjunctivitis may occur secondary to ocular medications, particularly neomycin.
  • Use of mydriatics in patients with glaucoma may precipitate acute narrow-angle glaucoma.

Prognosis

  • The prognosis is usually good, with full recovery of vision if treatment is prompt; however, if a corneal abrasion is left untreated, the outcome can be devastating.
  • Some deep abrasions (eg, those involving the corneal stromal layer) in the central visual axis (ie, the central area of the cornea directly over the pupil) heal, but they leave a scar. In these instances, visual acuity may be permanently lost.
  • Healing of minor abrasions is expected within 24-48 hours. Extensive or deep abrasions may require a week to heal.

Patient Education

Miscellaneous

Medicolegal Pitfalls

  • Failure to diagnose the corneal abrasion, failure to treat it adequately, failure to monitor the patient until the abrasion is healed, and failure to diagnose potentially devastating sequelae (eg, corneal ulcers) are pitfalls.
  • Strongly consider use of a slit lamp and fluorescein to diagnose a corneal abrasion in ambulatory patients; without the magnification of the slit lamp, small abrasions can be missed.
  • In patients with nonhealing abrasions, abuse of topical anesthetics must be considered.
  • Failure to consider the possibility of an intraocular foreign body or an ocular perforation, as warranted by the patient's history (eg, use of a string trimmer, metal-on-metal hammering), is a pitfall.
  • Failure to identify corneal ulceration and to treat it with appropriate antibiotics is a pitfall.
  • Use of mydriatics in patients with known glaucoma or failure to obtain the pertinent history is a pitfall.

Special Concerns

  • Patient with corneal abrasions that do not resolve with the use of routine prophylactic antibiotics must be evaluated for conditions that impede healing; examples are infection, neurotrophic keratopathy, and topical anesthetic abuse.
 


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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