A corneal abrasion is a scratch on the clear front surface of the eye, often from a fingernail, branch, makeup brush or contact lens. It is very painful, and it usually heals within 1 to 3 days once infection and a hidden foreign body are ruled out.
Key symptoms
- Sudden eye pain after a known injury
- Feeling of something in the eye
- Tearing and redness
- Sensitivity to light
- Mildly blurred vision
What you find on exam
- Visual acuity before anything else
- Pain relief with a topical anesthetic drop supports the diagnosis
- Fluorescein stain under blue light: bright green defect
- Evert the upper lid to look for a foreign body; vertical linear scratches suggest one
- Pupil shape and anterior chamber to exclude a penetrating injury
Tests
- Usually none beyond the fluorescein exam
- Seidel test if a penetrating injury is possible
- CT of the orbits if a high-speed metal fragment is possible (no MRI)
Treatment basics
- Topical antibiotic such as erythromycin ointment or polymyxin B with trimethoprim drops
- Contact lens wearers: fluoroquinolone drop to cover Pseudomonas, no lenses until healed
- Pain control with oral acetaminophen or ibuprofen; topical NSAID drops can help
- No patching, and no topical anesthetic to take home
- Recheck in 24 to 48 hours if large, central or not improving
Red flags
- Vision loss or a teardrop-shaped pupil, signs of a penetrating injury
- White infiltrate on the cornea, a sign of an ulcer
- Injury from high-speed metal or a chemical exposure
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Sources: NCCPA PANCE Content Blueprint; NBOME COMLEX-USA clinical presentations; AAMC Core Entrustable Professional Activities (Core EPAs). Written by Making Synapses. Making Synapses is not affiliated with these organizations.