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SYMPTOMS
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Eye pain, Eye discomfort, Photophobia, Foreign body sensation, Difficulty opening the eye, Excessive tearing, Decrease in vision especially if abrasion/laceration is centrally
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SIGNS
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Corneal abrasion: Conjunctival injection, Corneal epithelial defect, Corneal edema
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Signs of corneal perforation that can be associated with a corneal laceration include the following: · Shallow anterior chamber · Tear-drop pupil shape · Flat cornea · Presence of a hyphema · Iris prolapse
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WORK-UP
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Pupils (Tear-drop pupil could be a sign of a wound leak) | EOMs | Full eye exam with dilation (Should avoid dilation if there is iris prolapse through the wound, a foreign body in the anterior chamber, or globe rupture)
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Anterior segment OCT | Seidel sign | NaFl staining (Abrasion: Staining Laceration: Pooling) | Lid eversion (Rule out foreign body especially if there are vertical tracks of staining on the cornea)
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TREATMENT
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Corneal abrasion: Begin a topical antibiotic (Polytrim 1gtt QID or Moxeza 1gtt BID) until corneal abrasion heals which typically occurs in 24-48 hours. Patient should also use artificial tears 1tgtt QID. Oral NSAIDs may help with pain. Wear eye protection especially if corneal abrasion is work-related
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Corneal laceration: Patient should not rub eye
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(1) If a partial thickness corneal laceration presents, a soft bandage lens with a high DK value, amniotic membrane, and corneal glue such as cyanoacrylate can be attempted (If not healing, refer to corneal specialist ASAP)
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(2) If full-thickness corneal laceration presents, refer to a corneal specialist ASAP for further evaluation and treatment Oral NSAIDs may help with pain. Wear eye protection especially if corneal laceration is work-related
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FOLLOW-UP
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Corneal abrasion: Monitor in 24-48 hours for a follow-up. Small corneal abrasions or corneal abrasions that involve less than or equal to 50% of the cornea typically heal in 24-48 hours. Large corneal abrasions that involve greater than 50% of the cornea usually take 4-5 days to heal
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Corneal laceration: Monitor in 1-2 days to assure proper healing.
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ADDITIONAL LAB | TESTS
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None
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ETIOLOGY
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Corneal abrasion: Scratch of the corneal epithelium that can be due to various etiologies including debris, contact lenses, fingernails, makeup brushes, and tree branches
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Corneal laceration: Partial or full-thickness defect in the cornea (Deeper than a corneal abrasion) that is typically due to trauma from something sharp striking the cornea or something striking the cornea with significant force
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DIFFERENTIAL DX
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Corneal foreign body, Bacterial keratitis, Corneal ulcer
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NOTES
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Large corneal abrasions or corneal abrasions due to fingernail scratches can potentially be at risk for developing into corneal erosions
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Typically if Bowman’s layer is not involved, the corneal will heal without scarring
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The most common location of a corneal laceration is the inferior aspect of the cornea due to the presence of Bell phenomenon
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