Corneal Abrasion Workup

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

Approach Considerations

Strongly consider use of a slit lamp examination with fluorescein to diagnose a corneal abrasion in ambulatory patients; without the magnification of the slit lamp, small abrasions can be missed.

If ocular penetration with a retained foreign body is suspected, such as in a high-velocity injury (eg, lawn mower, string trimmer, hammering metal), then an ocular CT scan, ocular MRI (if the object is nonmetallic), or both are indicated.

If a corneal ulcer (eg, microbial keratitis) is suspected (because of prolonged symptoms and/or risk factors such as contact lens wear), consider obtaining bacterial cultures before instilling antibiotics.

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Slit Lamp Examination

A topical anesthetic (ie, proparacaine, tetracaine) may facilitate the slit-lamp examination. Severe photophobia that causes blepharospasm may require instillation of a cycloplegic agent (ie, cyclopentolate [Cyclogyl], homatropine) 20-30 minutes prior to examination.

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.

Fluorescein is applied using a paper strip applicator that is gently placed over the inferior cul-de-sac of the eye and allowing saline or anesthetic solution to drop into the eye. Once the patient blinks, the dye is spread over the cornea.

Fluorescein stains basement membrane that has been exposed by damage to the corneal epithelium. This causes the abrasion to appear green using cobalt blue light or a Wood's lamp.(See the images below.) Corneal abrasions associated with contact lenses tend to be punctate or can be larger in a round shape.

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

Multiple linear, vertical abrasions suggest a foreign body under the upper eyelid. See the image below. Evert the eyelid to look for blepharoconjunctival foreign bodies.

Corneal foreign body with cobalt blue lighting shoCorneal foreign body with cobalt blue lighting showing abrasion.

If the patient has suffered penetrating ocular trauma, then leaking aqueous humor may be seen (Seidel sign). Examine the anterior chamber for evidence of iritis (cells and flare).

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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.

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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.

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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