Corneal abrasions present with acute onset of eye discomfort, tearing, and often a foreign-body sensation. A "ciliary flush" (conjunctival injection hugging the limbus) may be seen. Visual acuity may be affected by large abrasions or those in the central visual axis. Photophobia and headache from ciliary muscle spasm may be present. Associated findings or complications include traumatic iritis, hypopyon, or a corneal ulcer. Fluorescein examination, preferably with a slit lamp, reveals the defect.
Emergency Department Treatment and Disposition
Instillation of topical anesthetic drops (ie, 0.5% solution of either proparacaine or tetracaine) facilitates examination while relieving pain and blepharospasm. A short-acting cycloplegic (eg, cyclopentolate 1%, homatropine 5%) may further reduce pain from ciliary spasm and should be considered in patients who complain of headache or photophobia. Oral opioid analgesics may be needed for pain control. NSAID eye drops (eg, diclofenac or ketorolac) are equally effective and avoid risks of sedation. Neither treatment with topical antibiotics nor patching has been scientifically validated. Routine use of these practices has been called into question. Tetanus prophylaxis is indicated. Follow-up is required for any patient who is still symptomatic after 12 to 24 hours.
Corneal Abrasion. Seen under magnification from the slit lamp, corneal abrasion can sometimes be appreciated without fluorescein staining. This abrasion is seen without using the cobalt blue light. (Photo contributor: Harold Rivera.)
Corneal Abrasion. The same abrasion as Fig. 4.1 is seen under magnification from the slit lamp with fluorescein stain using the cobalt blue light. (Photo contributor: Harold Rivera.)
Corneal Abrasion. Abrasions obscuring the visual axis benefit from close follow up with an ophthalmologist to ensure adequate healing. (Photo contributor: Lawrence B. Stack, MD.)
Foreign Body under the Upper Lid. Lid eversion is an essential part of the eye examination to detect foreign bodies. (Photo contributor: Lawrence B. Stack, MD.)
"Ice-Rink Sign." Multiple linear abrasions caused by upper lid foreign body. (Photo contributor: Aaron Sobol, MD.)
Mucus may simulate fluorescein uptake, but its position changes with blinking.
Multiple linear corneal abrasions, the "ice-rink sign," may result from an embedded foreign body adhered to the upper lid. The lid should always be everted to rule this out.
A high index of suspicion for penetrating injury should be maintained whenever mechanism includes grinding or striking metal, or high-velocity injuries from mowers or string trimmers. Fluorescein streaming away from an "abrasion" (Seidel test) ...