Conjunctival Abrasion/Laceration

Conjunctival Abrasion/Laceration
SYMPTOMS Ocular irritation, Eye pain, Foreign body sensation
SIGNS Conjunctival abrasion: Conjunctival injection
Conjunctival laceration: Conjunctival chemosis, Subconjunctival hemorrhage, Torn conjunctiva with retracted edges, Bare sclera
Look for other signs of ocular trauma including corneal abrasions, hyphema, uveitis, retinal detachments, etc
WORK-UP Pupils | EOMs | Full eye exam with dilation (Should avoid dilation if there uveal prolapse through the wound, a foreign body in the anterior chamber, or globe rupture) Seidel sign
NaFl staining (Abrasion: Staining Laceration: Pooling) Lid eversion (Rule out foreign body)
TREATMENT Abrasion: Use artificial tears and topical antibiotic (drop or ointment) until area is healed
Small laceration (<1cm): Lavage wound with sterile saline. Manipulate edges of conjunctiva together with q-tip. Use artificial tears and topical antibiotic (drop or ointment) until defect is closed. Consider a plastic shield to prevent rubbing at night and OTC analgesics
Large laceration: Refer to ophthalmologist for surgical repair
FOLLOW-UP Abrasion: Monitor in 2-3 days (Should heal within 24-48 hours) Small laceration: Monitor in 24-48 hours (Should heal with 7 days)
Large laceration: Patient will likely be evaluated by an oculoplastic specialist. Monitor yearly once confirmed to be stable/healed by oculoplastic specialist
ADDITIONAL LAB | TESTS CT scan of the brain, orbits, and face if suspecting: · Ruptured globe · Intraocular foreign body · Facial, orbital, intracranial fracture
ETIOLOGY Blunt or penetrating trauma that causes superficial damage of the conjunctival tissue (abrasion) or mechanical tearing of the conjunctival tissue (laceration)
DIFFERENTIAL DX Subconjunctival hemorrhage, Conjunctival foreign body
NOTES Signs of globe perforation include a subconjunctival hemorrhage, hyphema, shallow anterior chamber, low IOP, intraocular foreign body, positive Seidel’s sign, and iridodialysis