OcuLearning › Trauma

Corneal Abrasion

URGENT — Trauma

Symptoms

Sharp ocular pain.

Photophobia.

Foreign body sensation.

Tearing and discomfort with blinking.

Blurred vision.

History of mechanical trauma (scratch, hit, or contact lens use).

Clinical Findings

Corneal findings

  • Epithelial defect that stains with fluorescein.
  • Absence of underlying corneal opacification (opacification suggests infection or inflammation).

Associated signs

  • Conjunctival injection.
  • Eyelid edema.
  • Mild anterior chamber (AC) reaction.

Etiology

Mechanical trauma

  • Fingernails, tree branches, paper, makeup brushes, or contact lenses.
  • Residual defect following foreign-body removal.

Recurrent erosion syndrome

  • Spontaneous epithelial breakdown upon awakening due to weak basement-membrane adhesion (from prior trauma or EBMD).

Contact lens risks

  • High risk for bacterial ulcer, specifically Pseudomonas; must be treated as keratitis until proven otherwise.

Red Flags

Contact lens wearer → never patch; must cover for Pseudomonas; culture if infiltrate appears.

Vegetable matter or soil contamination → high risk for fungal or gram-negative infection; low threshold for scraping.

Non-healing defect (>5 days) → consider recurrent erosion, neurotrophic keratopathy, or occult infection.

Associated hyphema or iritis → rule out open globe or occult intraocular foreign body (IOFB).

Investigations

Clinical assessment

  • Slit-lamp exam with fluorescein dye.
  • Document size (height × width) and diagram the location of the defect.

Critical checks

  • Evert eyelids to rule out retained foreign bodies (especially with vertical/linear abrasions).
  • Inspect for stromal infiltrates or opacification (infection signs).
  • Assess AC reaction and check for hyphema.
  • Rule out corneal laceration or penetrating trauma.

Treatment

Antibiotic coverage

  • Standard: Erythromycin, bacitracin, or Polytrim ointment/drops QID.
  • Organic/Vegetable trauma: Fluoroquinolone drops (moxifloxacin, ofloxacin) or ciprofloxacin ointment ≥ QID.
  • Contact lens wearer: Mandatory antipseudomonal fluoroquinolone; NO patching.

Pain management

  • Topical NSAIDs: Ketorolac 0.4–0.5% QID for 3 days (avoid in chronic surface disease).
  • Cycloplegics: Use for significant photophobia; avoid long-acting agents in small defects.
  • Oral meds: Acetaminophen or systemic NSAIDs.
  • Warning: NEVER prescribe topical anesthetics for home use (risks corneal melt and delayed healing).

Mechanical management

  • Debride loose or hanging epithelial flaps with a cotton-tipped applicator.
  • Bandage soft contact lens (BCL): May improve comfort in large defects.
  • Steroids: Strictly avoided while epithelial defect is active.

Clinical Pearl

Never prescribe topical anesthetics for home use; they cause corneal melt. Never patch a contact lens wearer; it facilitates Pseudomonas infection.

Differential Diagnosis

  • Recurrent corneal erosion syndrome
  • Corneal ulcer (bacterial or viral)
  • Subtarsal foreign body
  • Exposure keratopathy

Related Trauma Conditions