Corneal Abrasion/Laceration

Corneal Abrasion/Laceration
SYMPTOMS Eye pain, Eye discomfort, Photophobia, Foreign body sensation, Difficulty opening the eye, Excessive tearing, Decrease in vision especially if abrasion/laceration is centrally
SIGNS Corneal abrasion: Conjunctival injection, Corneal epithelial defect, Corneal edema
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
WORK-UP 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)
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)
TREATMENT 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
Corneal laceration: Patient should not rub eye
(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)
(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
FOLLOW-UP 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
Corneal laceration: Monitor in 1-2 days to assure proper healing.
ETIOLOGY Corneal abrasion: Scratch of the corneal epithelium that can be due to various etiologies including debris, contact lenses, fingernails, makeup brushes, and tree branches
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
DIFFERENTIAL DX Corneal foreign body, Bacterial keratitis, Corneal ulcer
NOTES Large corneal abrasions or corneal abrasions due to fingernail scratches can potentially be at risk for developing into corneal erosions
Typically if Bowman’s layer is not involved, the corneal will heal without scarring
The most common location of a corneal laceration is the inferior aspect of the cornea due to the presence of Bell phenomenon