Introduction
Background
The cornea is a transparent cover over the anterior part of the eye that serves several purposes: protection, refraction, as well as filtration of some ultraviolet light. It has no blood vessels and receives nutrients through tears as well as from the aqueous humor. It is innervated primarily by the ophthalmic division of the trigeminal nerve as well as the oculomotor nerve.
Pathophysiology
The cornea is composed of 5 layers (anterior to posterior): the corneal epithelium, Bowman’s layer, corneal stroma, Descemet’s membrane, and the corneal endothelium. A corneal abrasion is a violation in the surface of the most superficial layer, the epithelium.
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
The exact frequency of emergency department visits for corneal abrasions is unknown. A survey completed in 1985 showed that around 3% of all cases to general practitioners were corneal abrasions.1 In the United States, 65,000 work-related eye injuries and illnesses that cause missed time from work occur each year.2
International
The rates of corneal abrasions have been reported at 12.5% at eye casualty departments in the United Kingdom.3 A study by Wong et al looked at the incidence of ocular injury in US automobile workers between July 1989 and June 1992 at 33 UAW-Chrysler Corporation plants. A total of 1983 work-related eye injuries occurred, with 86.7% of cases being superficial foreign bodies and corneal abrasions.4
Mortality/Morbidity
Corneal abrasions can lead to lost time from work. A large study completed in the automobile industry showed that 32% of workers with eye injuries were unable to resume their normal duties for at least one day. Unfortunately, only 25% of workers in this study were wearing eye protection at the time of injury.4 A retrospective review from Torino, Italy, showed that ocular injuries including corneal abrasions were associated with a significant morbidity.5
Nevertheless, significant morbidity is uncommon but can be seen with infectious complications. Recurrent erosions are a common complication of abrasions, particularly in patients with epithelial basement membrane dystrophy.
In addition, corneal abrasions associated with contact lenses can progress to bacterial keratitis and lead to further ocular damage (including perforation or corneal scarring) if not treated promptly.6
Race
No evidence exists of a racial predisposition to corneal abrasions.
Sex
Looking at automotive workers, men have a higher incidence of injury when compared to women of all ages.4
Age
Incidence of corneal abrasion is more common in younger, active individuals. Automotive workers between the ages of 20-29 years had the highest incidence of eye injuries.4
Clinical
History
- Eye pain (occasionally severe), tearing, and foreign-body sensation are present.
- Patients sometimes complain of a foreign body sensation while keeping the eye shut. Other symptoms include photophobia, pain with extraocular movement, tearing, or blurred vision.
- A history of blunt or sharp trauma can usually be elicited.
- A detailed history with questions regarding recent sports activities, makeup application, excessive rubbing of the eyes, use of contact lenses (including poorly fitting lenses and duration of use), and motor vehicle accidents, should be elicited.
- The occupation of the patient should be noted because certain people exposed to metals may have penetrating globe injuries.
- Unconscious patients, such as ICU patients who are sedated and have lost their corneal reflexes, are prone to iatrogenic corneal abrasions.
Physical
- The eyes should be opened with the lids retracted in order to get a full look at the cornea as well as conjunctiva. Extraocular movements should be assessed, and the pupillary reflex should be elicited. Occasionally, the patient may have a reactive miosis.
- If there is any history or signs of globe injury with violation of ocular contents, a plastic or metal shield should be placed and an ophthalmologist should be called urgently.
- Visual acuity should be assessed. If the abrasion affects the visual axis, then there may be a deficit in acuity that should be apparent when compared to the uninjured eye.
- If the examination is limited by pain, then a topical anesthetic such as tetracaine or proparacaine may be used. The amount of anesthetic used should be minimal, as these agents have been shown to slow wound healing.7
- Visual inspection for foreign objects should be performed. Both upper and lower eyelids should be flipped in order to look for foreign bodies that may be lodged in the upper eyelid causing injury with eye blinking. Also see, Foreign Body, Intraocular.
- The cornea can become hazy if there is edema due to the abrasion. Conjunctival injection usually located near the limbus may also be present.
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 foreign body.
Corneal foreign body after removal.
- 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 abrasion-like 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
Corneal keratitis and staining.
More on Corneal Abrasion |
 Overview: Corneal Abrasion |
| Differential Diagnoses & Workup: Corneal Abrasion |
| Treatment & Medication: Corneal Abrasion |
| Follow-up: Corneal Abrasion |
| Multimedia: Corneal Abrasion |
| References |
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References
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Further Reading
Keywords
corneal abrasion, corneal epithelial defect, corneal abrasion treatment, scratched cornea, scraped eye, scraped cornea, eye trauma, scratched eye, corneal surface
