eMedicine Specialties > Emergency Medicine > Ophthalmology

Corneal Abrasion

Author: Robert M Howell, MD, FACEP, Associate Clinical Professor, Department of Family Medicine, Creighton University School of Medicine; Consulting Staff, Department of Emergency Medicine, Creighton University Medical Center/Saint Joseph Hospital
Contributor Information and Disclosures

Updated: Jul 27, 2007

Introduction

Background

Corneal abrasion is a scraping away or denuding of the corneal surface resulting from external forces physically applied to the corneal surface.

For related information, see Medscape's Cornea and External Disease Resource Center.

Pathophysiology

The cornea of the eye and, commonly, the bulbar conjunctiva, are affected. Minor or superficial abrasions involve only the corneal epithelium. Severe injuries also involve the deeper, thicker stromal layer.

Frequency

United States

Corneal abrasions are a common ophthalmologic cause of ED visits.

Mortality/Morbidity

Death is uncommon. Significant morbidity is uncommon but is mostly observed in conjunction with infectious complications or allergies to medications used in treatment. Recurrent erosions are a common complication of abrasions, particularly in patients with epithelial basement membrane dystrophy.

Age

Incidence of corneal abrasion is more common in younger, active individuals. Occurrence is unusual in elderly adults.

Clinical

History

  • Eye pain (occasionally severe), tearing, and foreign-body sensation are present.
  • Photophobia with blepharospasm is common, particularly if the abrasion is large or the presentation is delayed.
  • A history of blunt or sharp trauma can usually be elicited.
  • A history of extended contact lens wear is not uncommon.
  • Unconscious patients are prone to iatrogenic corneal abrasions.

Physical

  • Bulbar conjunctival injection is usually present.
  • Visual acuity is usually normal, unless the abrasion lies within the central visual axis or is large (with the usual corneal endothelial folds and anterior chamber reaction associated with such abrasions).
  • Corneal fluorescein staining: Examination with a cobalt blue slit lamp or a Wood light reveals fluorescein uptake whenever corneal epithelial cells are damaged or lost.

Causes

  • Injury (eg, fingers, fingernails, paper, mascara brushes, tree branches, self-inflicted rubbing, pepper-spray exposure, automotive frontal air bags)
  • Blowing dust, sand, or debris
  • Extended contact lens wear
  • Ocular foreign bodies imbedded under an eyelid
  • Iatrogenic - Unconscious patients, accidental injury by health care workers, improper eyelid patching in patients with Bell palsy, and other neuropathies in which the eyelid cannot be closed voluntarily
  • Other causes or risk factors
    • Corneal foreign bodies - Objects difficult to see (eg, small glass fragments)
    • Corneal perforation - Distorted pupil (sometimes), leaking aqueous humor (sometimes leaks from corneal perforations become visible when fluorescein is applied), low intraocular pressure (IOP), history of high-velocity injury (eg, lawn mowers, string trimmers), or metal-on-metal hammering
    • Corneal ulcer (microbial keratitis) - Fluorescein stain with an additional underlying or surrounding corneal infiltrate (eg, white spot, haze)
    • Keratitis or keratoconjunctivitis - Diffuse punctate fluorescein staining of the cornea, with or without conjunctivitis
    • Recurrent epithelial erosion - Rather sudden onset (usually on awakening) of abrasionlike symptoms, days to weeks after a healed abrasion caused by shearing injury (eg, fingernail, mascara brush)
    • Ultraviolet keratitis - History of exposure to electric arc welding or tanning beds without proper eye protection, history of prolonged exposure to bright sunlight without sunglasses (eg, "snow blindness"), delayed onset of symptoms (several hours); diffuse punctate fluorescein staining of cornea

More on Corneal Abrasion

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

  1. Flynn CA, D'Amico F, Smith G. Should we patch corneal abrasions? A meta-analysis. J Fam Pract. Oct 1998;47(4):264-70. [Medline].

  2. Michael JG, Hug D, Dowd MD. Management of corneal abrasion in children: a randomized clinical trial. Ann Emerg Med. Jul 2002;40(1):67-72. [Medline].

  3. Weaver CS, Terrell KM. Evidence-based emergency medicine. Update: do ophthalmic nonsteroidal anti-inflammatory drugs reduce the pain associated with simple corneal abrasion without delaying healing?. Ann Emerg Med. Jan 2003;41(1):134-40. [Medline].

  4. Benson WH, Snyder IS, Granus V, Macsai MS. Tetanus prophylaxis following ocular injuries. J Emerg Med. Nov-Dec 1993;11(6):677-83. [Medline].

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  6. Brown MD, Cordell WH, Gee AS. Do ophthalmic nonsteroidal anti-inflammatory drugs reduce the pain associated with simple corneal abrasion without delaying healing?. Ann Emerg Med. Oct 1999;34(4 Pt 1):526-34. [Medline].

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  17. Ostler HB. Risk of tetanus from corneal injuries. JAMA. 1988;260:553.

  18. Patterson J, Fetzer D, Krall J. Eye patch treatment for the pain of corneal abrasion. South Med J. Feb 1996;89(2):227-9. [Medline].

  19. Salz JJ, Reader AL, Schwartz LJ, Van Le K. Treatment of corneal abrasions with soft contact lenses and topical diclofenac. J Refract Corneal Surg. Nov-Dec 1994;10(6):640-6. [Medline].

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Further Reading

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Keywords

corneal abrasion, scratched cornea, scraped eye, scraped cornea, eye trauma, scratched eye, corneal surface

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Contributor Information and Disclosures

Author

Robert M Howell, MD, FACEP, Associate Clinical Professor, Department of Family Medicine, Creighton University School of Medicine; Consulting Staff, Department of Emergency Medicine, Creighton University Medical Center/Saint Joseph Hospital
Robert M Howell, MD, FACEP is a member of the following medical societies: American College of Emergency Physicians
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: Nothing to disclose.

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, Program Director, Department of 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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