What Is Corneal Abrasion?

If you suspect you have a corneal abrasion, watch out for symptoms like eye pain, redness, sensitivity to light, and blurred vision. A corneal abrasion is a scratch on the eye's surface. It is frequently caused by an accident, such as a fingernail or contact lens. It is quite painful when it happens, and medical treatment should be sought. A combination of eye drops appears to be the quickest and most effective technique to heal an abrasion. Seeking immediate medical attention from an eye care professional is essential for a proper diagnosis and appropriate treatment to promote healing and relieve discomfort.

Overview

A corneal abrasion is a defect on the epithelial surface of the cornea. It typically is traumatic, although it can happen on its own due to dry eyes or neurotrophic eyes.¹ Corneal abrasion (CA) is the most frequent ocular injury, with reported data ranging from 0.17% to 44% of the population. While long-term problems from corneal abrasions are rare, their impact is unexpected, unpleasant, and stressful for the patient. Patients may have blurred vision, excessive tears, redness, photophobia, and a foreign body sensation in their eyes.² Corneal abrasions can be categorised as traumatic, which includes foreign body and contact lens-related abrasions, or spontaneous abrasions.³

Causes of corneal abrasion

Tree branches, cosmetics brushes, industrial dirt, and sports equipment can all cause corneal abrasions. Many cases are also a result of sand and other microscopic particles which can irritate the cornea, especially if you rub your eyes. Contact lenses that have been damaged or worn for an extended period may increase your chances of getting a scratched cornea.^3,4

Signs and symptoms of corneal abrasion

Corneal abrasion symptoms include:

• Eye discomfort
• Excessive tearing of the eyes 
• Poor vision or changes in vision
• Photophobia
• Red eye
• A sense of a foreign substance in the eye^4,5

Management and treatment for corneal abrasion

The basis of therapy has been the use of topical antibiotics and, for larger abrasions, cycloplegics, coupled with regular follow-up until the eye has healed. Tetanus vaccination is given additionally for penetrating eye injuries.³ 

Patching the affected eye is occasionally indicated to reduce photophobia and the discomfort associated with ciliary accommodation (adjustment of the lens to view objects at different distances).⁵

Small abrasions that cause moderate discomfort

• Apply chloramphenicol ointment until the eye is comfortable
• Follow up only if the eye becomes uncomfortable^1,5

Abrasions that are large (> 4 mm) and with severe pain

• Application of chloramphenicol ointment, diclofenac drops 0.1%, and cyclopentolate 1% to the afflicted eye as per the physician’s orders is helpful
• Patients may also be informed that their eyesight will be clouded as a result of the cyclopentolate and that they should avoid activities such as driving
• Patients are reassessed in 24 hours; if symptoms improve, there is no need to reassess unless they deteriorate again^1,5

If a foreign substance is identified in the cornea, an attempt might be made to remove it with a swab, or irrigation under direct view. If irrigation or a cotton swab are ineffective in removing the foreign material, a 25-gauge needle or an eye spud can be used to remove the object after topical anaesthesia has been applied.^3,5

If you believe you may have a corneal abrasion, it is important to see your GP and use the medications as prescribed by the professional. 

Diagnosis of corneal abrasion

Your GP will collect a complete but focused history and perform a physical examination, as with any eye issue. Visual acuity and pressure measures are taken, followed by fluorescein testing.⁵ 

The eye examination starts with the use of a penlight. A pupil that is unusually formed might indicate globe rupture. Topical anaesthetics may be offered to help make the examination more comfortable. Typically,  conjunctival redness is present. Corneal opacity or infiltrates can arise as a result of corneal ulcers or infection. A cloudy cornea indicates oedema caused by excessive rubbing. 

Abrasions to the centre of the cornea will cause visual changes. Significant reductions in your visual acuity may necessitate consultation with an ophthalmologist. Extraocular motions are documented.³ Fluorescein drops with a blue light testing is done to make abrasions visible and assist in prompt diagnosis.¹

Risk factors

• Eye trauma - can happen when foreign objects, including dust particles, dirt, or contact lenses, make contact with the cornea
• Lack of eye protection - can result in trauma to the cornea by a foreign object, leading to abrasions⁵
• Contact lens use - contact lens wear, particularly if not correctly fitted, cleaned, or maintained, can result in corneal abrasions
• Working in the automotive industry - exposure to airborne particles or chemicals in certain vocations or activities can increase the risk of corneal abrasion⁴

Complications

Small corneal abrasions normally heal without issues, while bigger abrasions produce the following:

• Corneal ulcers
• Bacterial keratitis
• Recurrent erosion syndrome
• Traumatic iritis³

FAQs

How can I prevent corneal abrasion

Wear protective eyewear during activities that pose a risk of eye damage, maintain good contact lens hygiene, and avoid forcefully rubbing your eyes. Treat any dry eye symptoms as soon as possible with lubricating eye drops, and seek medical assistance if you suspect a corneal abrasion or are experiencing associated symptoms.

How common is corneal abrasion

Corneal abrasion is rather common, particularly in high-risk groups or occupations. Corneal abrasions are estimated to account for 10% of all eye-related emergency room visits. The actual incidence, on the other hand, may vary based on factors such as geographical region, lifestyle, and individual risk factors.

When should I see a doctor

If you have severe eye discomfort, persistent redness, hazy vision, increased sensitivity to light, or the injury was caused by a large trauma or foreign object, you should visit a doctor for a corneal abrasion. Seeking medical assistance as soon as possible is critical for avoiding complications and receiving adequate treatment for corneal abrasions.

Summary

Corneal abrasion is the scratching or scraping of the cornea, which is the clear front section of the eye. It usually happens as a result of an eye injury or trauma, such as foreign objects, contact lenses, or inadvertent eye rubbing. 

Corneal abrasion symptoms include eye discomfort, redness, weeping, sensitivity to light, and the sensation of something in the eye. Protecting the eye from additional injury and aiding recovery are the goals of corneal abrasion therapy. 

Patching the damaged eye, using lubricating eye drops or ointments to relieve discomfort, and avoiding activities that might aggravate the injury, are all solutions. To avoid infection, antibiotic eye drops or ointments may be administered. Regular follow-up with an eye care specialist is required to monitor the healing course of a corneal abrasion. 

Complications from corneal abrasion might include corneal infection, corneal ulceration, or scarring, which can impair vision if not addressed swiftly. Participating in activities with a high risk of eye injury, such as sports or vocations involving flying debris, is one of the risk factors for corneal abrasion. Wearing contact lenses for lengthy periods of time or failing to practise adequate contact lens cleanliness can also raise the risk. Dry eye syndrome, as well as other eye disorders that damage the cornea, may render it more prone to abrasions. 

Prompt diagnosis, treatment, and preventative actions can help reduce the risks and effects of corneal abrasion.