Simeon Harrow
Introduction
Corneal abrasions are defects in the epithelial surface of the cornea (1). The cornea is particularly exposed to injury as it forms the outermost layer of the eye. The function of the cornea involves forming a protective shield for the eye, filtration of ultraviolet light and to facilitate the refraction of light onto the retina (1,2). Corneal abrasions typically result from injury due to mechanical trauma such as from fingernails, tree branches, makeup brushes or contact lens use. Other documented causes include burn injuries and foreign bodies. In the UK, presentation of corneal injuries and foreign bodies to primary care have been reported as 3.2 and 2.7 cases respectively per 1000 people each year (3).
Presentation
Notably, patients commonly report a history of eye trauma, however corneal abrasions can be caused by minor injury to the surface of the eye such as from eye rubbing. Symptoms typically include report of a painful eye, erythema, photophobia, excessive lacrimation, blurred vision and foreign body sensation (1). Furthermore, patients may report the exacerbation of symptoms due to eye rubbing, excessive light exposure and blinking (4).
Diagnosis
Diagnosis of corneal abrasion involves focused history taking to note possible ocular injuries, symptoms and clinical examination. The cornea is examined using a slit lamp microscope under cobalt-blue light, following fluorescein staining of the affected eye. The corneal abrasion is visualized and confirmed due to its bright green appearance. In addition, it is vital to closely examine for the presence of foreign bodies, which must be assessed and carefully removed (4).
Differential Diagnosis
It is important to be mindful of other conditions which present with similar symptoms, due to significant differences in management. Differential diagnoses for corneal abrasions include conjunctivitis, acute angle-closure glaucoma, uveitis, dry eye syndrome, infective keratitis and recurrent erosion syndrome (1).
Management
Uncomplicated corneal abrasions can usually be managed in primary care, with the aim of preventing any bacterial infection with antibiotic ointment and providing comfort with lubricating eye drops and analgesia. Mild cases typically resolve within 1-2 days.
However, complicated corneal abrasions may involve recurrence, significant vision loss, penetrating eye injury, corneal infiltrate, hypopyon or hyphema, burn injury or deterioration of symptoms following 24 hours of initial treatment. These severe abrasions require urgent review by an ophthalmologist for further management and close follow-up (1).
References
- Wipperman JL, Dorsch JN. Evaluation and management of corneal abrasions. American family physician. 2013 Jan 15;87(2):114-20.
- Ludwig PE, Lopez MJ, Sevensma KE. Anatomy, head and neck, eye cornea.
- NICE CKS, Corneal Superficial injury, Available at:https://cks.nice.org.uk/topics/corneal-superficial-injury/background-information/prevalence/
- MD SA, MD AL. Management of corneal abrasions. American family physician. 2004 Jul 1;70(1):123-8.