eMedicine Specialties > Emergency Medicine > Ophthalmology

Corneal Abrasion: Follow-up

Author: Feras H Khan, MD, Resident Physician, Department of Emergency Medicine, State University of New York Downstate, Kings County Hospital, Brooklyn
Coauthor(s): Mark A Silverberg, MD, FACEP, MMB, Assistant Professor, Assistant Residency Director, Department of Emergency Medicine, State University of New York Downstate College of Medicine; Consulting Staff, Department of Emergency Medicine, Staten Island University Hospital, Kings County Hospital, University Hospital, State University of New York Downstate at Brooklyn
Contributor Information and Disclosures

Updated: Jul 27, 2009

Follow-up

Further Inpatient Care

  • Patients with corneal abrasions are managed on an outpatient basis.

Further Outpatient Care

  • The patient should be seen by an ophthalmologist within 24-48 hours to assess for healing. Usually, abrasions heal quickly within 24 hours, and patients will not need long-term follow-up. Patients with contact lens – associated abrasions or large abrasions may need to follow up over the course of 3-5 days to ensure healing and avoid infection.
  • Advise eye rest (ie, no reading or work that requires significant eye movement that might interfere with reepithelialization).
  • Advise patients to avoid light or to wear sunglasses for comfort if significant photophobia exists.

Inpatient & Outpatient Medications

  • Antibiotics should be continued until the patient is asymptomatic.
  • Narcotic analgesics (eg, oxycodone, hydrocodone) frequently are needed for severe pain until pain can be managed with over-the-counter analgesics.
  • Cycloplegics may be required twice a day for large abrasions with significant photophobia, blepharospasm, or both, until healing is nearly complete.

Deterrence/Prevention

  • Persons who work in high-risk occupations such as auto-mechanics, metalworkers, or miners should wear protective eyewear. People who participate in contact sports such as hockey, lacrosse, or racquet sports such as squash or racquetball should always wear protective eyewear.
  • Encourage patients to wear protective eyewear when working at jobs that have an increased risk of corneal abrasion or UV exposure or when hiking through areas of tall foliage.
  • Tape eyelids closed in unconscious patients and in those who cannot voluntarily close their eyelids (eg, Bell palsy, other neuropathies).
  • Patients who wear contact lenses should make sure they fit properly and change them accordingly.

Complications

  • Recurrent epithelial erosion sometimes occurs days to weeks after a formerly healed abrasion caused by shearing injury (eg, fingernail, mascara brush). These erosions may be caused by damage to the basement membrane (to which the newly healed overlying cells do not adhere well) and subsequent slough due to mild hypoxia that occurs during sleep. Patients typically are 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 (microbial keratitis) secondary to infected abrasions are more common after contact lens – related abrasions.
  • Ocular tetanus (rare)
  • Allergic conjunctivitis, secondary to ocular medications, particularly neomycin
  • Acute narrow-angle glaucoma precipitated by using mydriatics in patients with glaucoma

Prognosis

  • In the vast majority of patients, the prognosis is excellent with full recovery including visual acuity.
  • Some deep abrasions (involving the corneal stromal layer) within the central visual axis (ie, the central area of the cornea directly over the pupil) heal but leave a scar. In these instances, a permanent loss of visual acuity may occur.
  • Healing of minor abrasions is expected within 24-48 hours. More extensive or deeper abrasions may require a week to heal.

Patient Education

Miscellaneous

Medicolegal Pitfalls

  • Failure to consider the possibility of an intraocular foreign body or ocular perforation if history warrants (eg, string trimmer use, metal-on-metal hammering)
  • Failure to identify corneal ulceration and treat with appropriate antibiotics
  • Use of mydriatics in patients with known glaucoma or failure to obtain history
 
Acknowledgments

I would like to thank Samala Khan, OD, for supplying the visual images.

The authors and editors of eMedicine gratefully acknowledge the contributions of previous author, Robert M Howell, MD, to the development and writing of this article.



More on Corneal Abrasion

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

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Keywords

corneal abrasion, corneal epithelial defect, corneal abrasion treatment, scratched cornea, scraped eye, scraped cornea, eye trauma, scratched eye, corneal surface

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Contributor Information and Disclosures

Author

Feras H Khan, MD, Resident Physician, Department of Emergency Medicine, State University of New York Downstate, Kings County Hospital, Brooklyn
Feras H Khan, MD is a member of the following medical societies: American College of Emergency Physicians, Emergency Medicine Residents Association, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

Coauthor(s)

Mark A Silverberg, MD, FACEP, MMB, Assistant Professor, Assistant Residency Director, Department of Emergency Medicine, State University of New York Downstate College of Medicine; Consulting Staff, Department of Emergency Medicine, Staten Island University Hospital, Kings County Hospital, University Hospital, State University of New York Downstate at Brooklyn
Mark A Silverberg, MD, FACEP, MMB is a member of the following medical societies: American College of Emergency Physicians, American Medical Association, Council of Emergency Medicine Residency Directors, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

Medical Editor

Debra Slapper, MD, Consulting Staff, Department of Emergency Medicine, St Anthony's Hospital
Debra Slapper, MD is a member of the following medical societies: American Academy of Emergency Medicine
Disclosure: Nothing to disclose.

Pharmacy Editor

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

Managing Editor

Douglas Lavenburg, MD, Clinical Professor, Department of Emergency Medicine, Christiana Care Health Systems
Douglas Lavenburg, MD is a member of the following medical societies: American Society of Cataract and Refractive Surgery
Disclosure: Nothing to disclose.

CME Editor

John D Halamka, MD, MS, Associate Professor of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center; Chief Information Officer, CareGroup Healthcare System and Harvard Medical School; Attending Physician, Division of Emergency Medicine, Beth Israel Deaconess Medical Center
John D Halamka, MD, MS is a member of the following medical societies: American College of Emergency Physicians, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

Chief Editor

Barry E Brenner, MD, PhD, FACEP, Professor of Emergency Medicine, Professor of Internal Medicine, Program Director, Emergency Medicine, University Hospitals, Case Medical Center
Barry E Brenner, MD, PhD, FACEP is a member of the following medical societies: Alpha Omega Alpha, American Academy of Emergency Medicine, American College of Chest Physicians, American College of Emergency Physicians, American College of Physicians, American Heart Association, American Thoracic Society, Arkansas Medical Society, New York Academy of Medicine, New York Academy of Sciences, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

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