Corneal Abrasion

A corneal abrasion is a painful scratch on the eye.

• A corneal abrasion is a painful scrape or scratch of the surface of the clear part of the eye. This clear tissue of the eye is known as the cornea, the transparent window covering the iris, the circular colored portion of the eye. The cornea has many nerve endings just under the surface, so that any disruption of the surface may be painful.
• Seek medical care for sudden vision loss, severe eye pain, or an eye injury.
• Treatment may incorporate antibiotics, anesthetic eyedrops, and/or an eye patch.

• A corneal abrasion may occur when something hits your eye. For example, while hiking, if the person in front of you pushes and lets go of a tree branch, it could hit your eye, causing an abrasion to the cornea.
• A corneal injury may occur when something gets into your eye, for example, when the wind blows a dried leaf particle into your eye or when paint chips fall into your eye while you are scraping off old paint. This material may scratch the cornea.
• A foreign body, such as a piece of sand or wood, may lodge under the inside of the upper lid and cause scratches of the corneal surface every time that you blink.

Basic anatomy of the eye.
• In addition to causing corneal injury, high-speed particles may penetrate your eye and injure deeper structures. An example of this would be a small metal fragment flying into the eye when a person is using a grinding wheel without protective eyewear. This may cause a serious injury that demands immediate medical attention to guard against permanent loss of vision.
• A hot cigarette ash flying into the eye may cause a corneal abrasion.
• A common cause of a corneal abrasion is a young child accidentally poking you in the eye with her fingernail.
• You may cause a corneal abrasion when you rub your eyes excessively when they are irritated.
• Wearing contact lenses longer than recommended may injure the corneal surface and cause a corneal abrasion.
• Certain eye infections may also cause injury to the surface of the cornea. This injury, although not technically considered a corneal abrasion, may be temporary or permanent.
• Exposure of the unprotected eye to ultraviolet light from sun lamps or welding arcs can cause changes in the corneal surface resembling corneal abrasions.

Risk factors for the development of corneal abrasions include:

• outdoor activities,
• having young children,
• using power tools without eye protection,
• wearing contact lenses,
• using chemical solutions without eye protection,
• suffering trauma to the face, including facial surgery, and disorders of the eyelids or eyelashes.

You should suspect a corneal abrasion if you have sustained an injury to your eye. The following are some of the symptoms you may experience:

• A sensation of a foreign body in the eye (for example, a feeling that there is something in your eye that you cannot get out). This feeling sometimes develops a few hours later rather than immediately after the apparent injury.
• Corneal abrasions, except in cases of chemical or ultraviolet light burns, usually affect only one eye.
• Tearing of the eyes
• Blurred vision or distortion of vision
• Eye pain when exposed to a bright light
• Spasm of the muscles surrounding your eye causing you to squint

You should see your ophthalmologist (a medical doctor who specializes in eye care and surgery of the eyes) if you experience any of the following:

• You have eye pain, with or without an associated eye injury.
• You experience a sudden loss of vision or a sudden significant blurring of vision.
• You receive an eye injury from high-speed equipment that could cause a fragment to go into your eye, such as from a grinding wheel, from hammering upon metal, or from sanding or sawing while doing carpentry.

Cross-section of the orbit with anatomical view of the extraocular muscles in the eye.
• You have the feeling that there is something in your eye and you cannot get it out.
• Exposure to sunlight or bright indoor lights causes severe eye pain.
• You have eye redness.
• You are experiencing minor eye symptoms in the presence of a known eye condition or in the presence of having sight in only one eye.
• Your pain lasts more than a few hours or is severe. Also, seek medical help if you have eye pain and do not recall any injury to your eye.
• You have any heat or chemical burn to your eye.
• Pain returns from an eye injury that seemed to have resolved with treatment.

You should go to the hospital's emergency department if you experience any of the above and are unable to be evaluated by your ophthalmologist.

If you develop a corneal abrasion, you should be examined promptly by a medical professional. This person will often be an emergency physician or your family doctor. They are often able to diagnose and manage a corneal abrasion. If the initial physician feels that your problem needs specialized care, they will refer you to an ophthalmologist.

• What is the cause of my symptoms?
• How large is the corneal abrasion?
• Will I develop any scarring or permanent vision loss from the corneal abrasion?
• How can I prevent this injury from happening again?
• What can I expect to feel once the effects of the numbing eyedrops have worn off?
• When may I resume my regular activities?

• Inform your ophthalmologist of any previous eye problems, including injuries, or eye diseases, such as glaucoma, because certain eyedrops may worsen these conditions.
• Tell your ophthalmologist if you have any allergies. If you have any reaction to a prescribed medication, contact your ophthalmologist immediately.
• Your ophthalmologist may put a numbing eyedrop into your eye which will temporarily take away the pain and allow you to keep your eye open for the examination. Your ophthalmologist may also put a yellow-colored eyedrop into your eye and examine your eye with a blue light. This eyedrop contains a dye called fluorescein that makes corneal abrasions easier for the ophthalmologist to see during the examination.

• In cases of minor irritation, such as one resulting from a piece of dust flying into your eye, you may be able to wash out the foreign object from your eye with clean tap water.
  • You can rinse your eye by tilting your head back and pouring water into your opened eye.
  • You can also fill a sink with water and plunge your head into the water with your eyes open.
  • Laboratories and industrial settings where chemical contaminations are possible have eye wash stations to rinse out the eyes if necessary.
• Over-the-counter artificial tears or lubricants may improve the discomfort in your eye.
• Over-the-counter pain medicine, such as acetaminophen (Tylenol), may be helpful. If one dose of such medication does not bring relief, consult your ophthalmologist.
• After your eye examination, you should rest with your eyes closed to help the healing process. This means no reading. You should also not drive until your ophthalmologist says it is safe for you to do so, because driving with impaired vision poses a danger to yourself and others. Instead, have someone drive you to your appointment with the ophthalmologist.

Your ophthalmologist will treat the specific eye condition based on the diagnosis.

• Antibiotic eyedrops or ointment may be prescribed or placed in your eye or eyes. Some ophthalmologists may use steroid or nonsteroidal anti-inflammatory eyedrops to reduce inflammation and to avoid potential scarring.
• Eyedrops to stop eye muscle spasm may be placed into your eyes by your ophthalmologist. These drops may relieve your pain and your sensitivity to light, but they may also cause blurring of vision.

This corneal abrasion appears as a yellow-green area when stained with fluorescein and viewed with a blue light.
• The eye may or may not be patched by your ophthalmologist. Recent evidence shows that patching the eye probably does not help and may actually have a negative impact on the healing process. Whichever choice your ophthalmologist makes, it is not likely to be a significant issue. Your ophthalmologist may have specific reasons for your treatment based on the specific circumstances of your case. If you are in doubt about the ophthalmologist's decision, ask him or her why a certain choice has been made.
• If there is any evidence of rusty metallic deposits within the injured cornea, your ophthalmologist may recommend a tetanus vaccination if your immunization status is not up to date.
• Although anesthetic eyedrops may be used to immediately relieve the eye pain at the time of your examination, these drops cannot be prescribed for you to use at home because they interfere with the natural healing process.
  • Pain pills to be taken by mouth may be prescribed.
  • Wearing sunglasses may help relieve the pain due to light sensitivity.

If you have a simple corneal abrasion, your ophthalmologist may ask you to return for a recheck in 24-48 hours.

More serious or complex problems usually require a follow-up examination. If you have any unusual or unexpected symptoms, contact your ophthalmologist to discuss them.

Ask questions if you are not sure of the diagnosis or the treatment plan. Do not leave until you are sure when your next appointment is and under what circumstances you are to contact your ophthalmologist or to return before your next appointment.

Remember, unpredictable things happen, and medical problems do not always follow textbook descriptions.

To avoid eye injuries, you should adhere to the following preventive measures:

• Wear protective eyewear while participating in certain sports, such as racquetball.
• Wear protective eyewear in situations where objects may fly into your eyes. This might include wearing glasses or sunglasses while hiking to avoid windblown objects, as well as wearing protective eyewear that gives 180-degree protection while using a grinding wheel or hammering on metal. For welding, special eyewear is available and should be worn at all times.
• Wear protective eyewear to block ultraviolet radiation when you are in bright sunlight for long periods of time. This is especially important while skiing on water or on the beach because the reflection of sunlight off the snow, water, or light sand in combination with direct sunlight causes a doubling of sunlight exposure, potentially leading to corneal flash burns.

Corneal abrasions usually heal completely within 24-48 hours of the injury. However, in some cases, they may occasionally heal poorly and then recur without additional trauma. This condition is known as a recurrent corneal erosion and will sometimes follow an injury due to an evergreen branch or fingernail.

Other causes of eye pain and eye injuries may take longer to heal or may require more extensive treatment by your ophthalmologist.