Corneal injuries

Corneal Abrasion Treatment, Symptoms, Remedies, Pictures

Corneal injuries

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.

What Causes a Corneal Abrasion?

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  • 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.
  • 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.

What Are Risk Factors for 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.

What Are Corneal Abrasion Symptoms and Signs?

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

Pink Eye (Conjunctivitis) Symptoms, Causes, Treatments See Slideshow

When Should Someone Seek Medical Care for a Corneal Abrasion?

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.
  • 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.

What Types of Specialists Treat Corneal Abrasions?

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.

Questions to Ask the Doctor about Corneal Abrasion

  • 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?

What Tests Do Health Care Professionals Use to Diagnose a Corneal Abrasion?

  • 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.

What Are Home Remedies for a Corneal Abrasion?

  • 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.

What Is the Medical Treatment for a Corneal Abrasion?

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Your ophthalmologist will treat the specific eye condition 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.
  • 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 ly to be a significant issue. Your ophthalmologist may have specific reasons for your treatment 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.

What causes dry eyes? See Answer

Is Follow-up Needed for a Corneal Abrasion?

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.

Is It Possible to Prevent a Corneal Abrasion?

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.

What Is the Prognosis of a Corneal Abrasion?

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.

Corneal Abrasion Pictures

Basic anatomy of the eye.
Cross-section of the orbit with anatomical view of the extraocular muscles in the eye.
This corneal abrasion appears as a yellow-green area when stained with fluorescein and viewed with a blue light.

It is not unusual to have some general irritation, even some redness, upon beginning contact lens wear. However, persistent redness, light sensitivity, pain, and blurred vision are the main signs and symptoms of potential eye problems. Depending on the cause, symptoms vary in intensity. In more serious infections, the pupil in the infected (red) eye may be smaller than the other pupil.

  • Corneal abrasions (scratches) are usually quite painful, with or without the lens in the eye, and are associated with light sensitivity and redness. Vision may or may not be blurry.

Read more about contact lens problems »

Reviewed on 10/21/2019

References

Ahmed, F., R. House, and B. Feldman. “Corneal Abrasions and Corneal Foreign Bodies.” Primary Care: Clinics in Office Practice 42.3 September 2015: 363-375.

Arbour, J.D., I. Brunette, H.M. Boisjoly, Z.H. Shi, J. Dumas, and M.C. Guertin. “Should We Patch Corneal Erosions?” Arch Ophthalmol 115.3 Mar. 1997: 313-317.

Source: https://www.emedicinehealth.com/corneal_abrasion/article_em.htm

Management of Corneal Abrasions

Corneal injuries

STEPHEN A. WILSON, M.D.,and ALLEN LAST, M.D., University of Pittsburgh Medical Center St. Margaret Family Practice Residency Program, Pittsburgh, Pennsylvania

Am Fam Physician. 2004 Jul 1;70(1):123-128.

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Article Sections

Corneal abrasions result from cutting, scratching, or abrading the thin, protective, clear coat of the exposed anterior portion of the ocular epithelium. These injuries cause pain, tearing, photophobia, foreign body sensation, and a gritty feeling.

Symptoms can be worsened by exposure to light, blinking, and rubbing the injured surface against the inside of the eyelid. Visualizing the cornea under cobalt-blue filtered light after the application of fluorescein can confirm the diagnosis. Most corneal abrasions heal in 24 to 72 hours and rarely progress to corneal erosion or infection.

Although eye patching traditionally has been recommended in the treatment of corneal abrasions, multiple well-designed studies show that patching does not help and may hinder healing. Topical mydriatics also are not beneficial.

Initial treatment should be symptomatic, consisting of foreign body removal and analgesia with topical non-steroidal anti-inflammatory drugs or oral analgesics; topical antibiotics also may be used. Corneal abrasions can be avoided through the use of protective eyewear.

Most of the human eye lies within a protective bony orbit. The exposed anterior portion has other anatomic and functional protections. The eyebrow and eyelashes partially shield the eye from small particles.

Eyelids close rapidly and reflexively when ocular danger is sensed. A tear response attempts to wash away anything that reaches the ocular surface. Tears also lubricate the eye and prevent tissue dehydration.

Despite built-in protections, eye injuries still occur. One such injury is abrasion of the outermost layer of the eye. Although damage to the white part of the eye usually is of little significance, corneal abrasion can be serious. When minor abrasions occur, healthy cells quickly fill the defect to prevent vision-diminishing infection or irregularity in refraction.

If the abrasion penetrates the cornea more deeply, the healing process takes longer—24 to 72 hours.1,2 Deeper scratches can cause corneal scarring that can impair vision to the point where corneal transplant is needed. Specific incidence and prevalence data are not available, but corneal abrasion is the most common eye injury in children presenting to emergency departments.

3

The cornea (Figure 1) is a highly organized group of cells and proteins with three functions: barrier protection, filtration of some of the ultraviolet wavelengths in sunlight, and refraction (the cornea is responsible for 65 to 75 percent of the eye’s capacity to focus light on the retina). The cornea must be totally transparent to refract light properly. Therefore, it has no blood vessels and instead is nourished by tears, environmental oxygen, and the aqueous humor of the anterior chamber.

Within its thin dimensions—about 11.6 mm vertically, 10.5 mm horizontally, 1 mm thick peripherally, and 0.55 mm thick centrally—the cornea has five distinct, transparent layers; from anterior to posterior they are epithelium, Bowman’s layer, stroma, Descemet’s membrane, and endothelium (Figure 2).

A history of recent ocular trauma and subsequent acute pain suggests corneal abrasion. Other symptoms include photophobia, pain with extraocular muscle movement, excessive tearing, blepharospasm, foreign body sensation, gritty feeling, blurred vision, and headache. Symptoms can be present without the patient’s recollection of trauma and with as little trauma as aggressive eye rubbing.

The diagnosis of corneal abrasion can be confirmed by visualizing the cornea under cobalt-blue filtered light after the application of fluorescein, which will cause the abrasion to appear green (Figures 3 and 4) .

If examination is limited by pain, instillation of a topical anesthetic (e.g., proparacaine [Ophthetic], tetracaine [Pontocaine]) may be needed.

During the examination it is important to assess for and remove any foreign bodies, some of which may leave a rust residue (Figure 5) .

Rarely, simple corneal abrasions become complicated. Recurrent corneal erosion (RCE)—repeated, spontaneous disruption of corneal epithelium—can occur in corneal tissue weakened by abrasion months or years earlier.

Symptoms of RCE include ocular pain, foreign body sensation, photophobia, blepharospasm, decreased vision, and lacrimation on awakening or after rubbing or opening the eyes. These symptoms are annoying to the patient but typically are not severe enough to interfere with activities.4 Lesions usually are found near the original abrasion; they may recur only rarely or as often as daily.

True idiopathic or bilateral lesions suggest a basement membrane dystrophy, characterized by poor adhesion between the epithelial basement membrane and Bowman’s layer.

Although eye patches, topical antibiotics, and mydriatic agents traditionally have been used in patients with corneal abrasions, treatment recommendations recently have evolved. Current recommendations stress the use of topical or oral analgesics and topical antibiotics (Table 1) . Most corneal abrasions heal with this approach.

EYE PATCHING

Eye patching is no longer recommended for corneal abrasions.2,3,5 A meta-analysis of five randomized controlled trials (RCTs) failed to reveal an increase in healing rate or improvement on a pain scale.5 Two subsequent RCTs (one in children, one in adults) reported similar results.

2,3 In the past, patching was thought to reduce pain by reducing blinking and decreasing eyelid-induced trauma to the damaged cornea. However, the patch itself was the main cause of pain in 48 percent of patients.6 Children with patches had greater difficulty walking than those without patches.

3 Furthermore, patching can result in decreased oxygen delivery, increased moisture, and a higher chance of infection. Thus, patching may actually retard the healing process.7,8

TOPICAL ANALGESICS

Topical nonsteroidal anti-inflammatory drugs (NSAIDs) such as diclofenac (Voltaren) and ketorolac (Acular) are modestly useful in reducing pain from corneal abrasions.9 In a systematic review of five RCTs, topical NSAID use decreased pain by an average of 1.

3 cm on a standard 10-cm pain scale.9 Qualitatively, patients using topical NSAIDs indicated greater relief from pain and other symptoms.

9 Patients using topical NSAIDs may take fewer oral analgesics (two of three studies), return to work earlier (one study), and require fewer narcotics.9

Topical anesthetics should be avoided after the initial examination. They can retard healing and cause corneal damage.

MYDRIATICS

Mydriatics are no longer recommended for the treatment of pain in patients with corneal abrasions.

10 Mydriatics formerly were prescribed to relieve ciliary muscle spasm that was thought to occur in patients with corneal abrasions.

However, in one RCT with limited follow-up, pain was similar in patients using an eye lubricant or mydriatic (2 percent homatropine [Homapin]), alone or combined with a topical NSAID.10

TOPICAL ANTIBIOTICS

Because a concomitant infection can cause slower healing of corneal abrasions, some clinicians use prophylactic antibiotic treatment, although there is no strong evidence for this use.

A two-year, non–placebo-controlled, prospective cohort study11 of topical antibiotic prophylaxis for corneal abrasion showed that the use of 1 percent chloramphenicol ointment was associated with lower risk of subsequent ulcer, especially if prophylaxis began within 18 hours after the injury.

A single-blind, non–placebo-controlled randomized trial12 showed that corneal abrasions in patients treated with fusidic acid eye drops did not heal significantly faster than patients treated with chloramphenicol ointment.

If antibiotics are used, ointment (e.g., baci-tracin [AK-Tracin], erythromycin, gentamycin [Garamycin]) is more lubricating than drops and is considered first-line treatment. In patients who wear contact lenses, an anti-pseudomonal antibiotic (e.g.

, ciprofloxacin [Ciloxan], gentamycin, ofloxacin [Ocuflox]) should be used, and contact lens use should be discontinued.

Clinical trial data are lacking, but it is recommended that contact lenses be avoided until the abrasion is healed and the antibiotic course completed.13

ORAL ANALGESICS

No direct evidence is available from clinical trials for the efficacy of oral analgesics in the treatment of corneal abrasions. However, because most abrasions heal without significant long-term complications, pain relief is the primary concern and the basis for routine use of oral analgesics.

Oral analgesics are less expensive than topical preparations. No studies directly address the role, if any, of opioid analgesia. Individual patient characteristics (e.g.

, age, concomitant illness, drug allergy, ability to tolerate NSAIDs, potential for opioid abuse, employment conditions such as driving and machine operation) should guide therapy.

Most patients should be re-evaluated in 24 hours; if the abrasion has not fully healed, they should be evaluated again three to four days later.

Patients who wear contact lenses should be re-evaluated in 24 hours and again three to four days later even if they feel well. Any worsening of symptoms should prompt a thorough re-evaluation for foreign bodies or full-thickness injuries.

Immunocompromised or monocular patients also warrant closer attention and may require earlier ophthalmologic referral.

Referral to an ophthalmologist is indicated for patients with deep eye injuries, foreign bodies that cannot be removed, and suspected RCE.

Patients with persistent symptoms after three days, worsening symptoms, and symptoms that do not improve daily also should be referred.

Patients who wear contact lenses should be referred if there is no improvement in symptoms within a few hours of lens removal.

Most corneal abrasions are preventable. Persons in high-risk occupations (e.g., miners, woodworkers, metal workers, landscapers) and those who participate in certain sports (e.g., hockey, lacrosse, racquetball) should wear eye protection.

Levels of protection include plastic safety glasses, polycarbonate lenses of varying thickness, industrial safety goggles with polycarbonate, and helmets with facemasks. All provide barrier protection from airborne debris (e.g.

, sand, sawdust, metal) and other objects that could cause ocular trauma (e.g., fingernails, tree branches, sports balls). Eye guards without lenses are not sufficient.

Other preventive measures include careful fitting and placement of contact lenses, keeping the fingernails of infants and young children clipped short, and removing low-hanging tree branches or objects from the home environment.

Corneal abrasion, the most common peri-operative ocular injury, results from lagophthalmos during general anesthesia. It can be prevented by taping the patient’s eyelids closed or instilling soft contact lenses or aqueous gels; paraffin-based ointments (e.g., Lacrilube, Duratears) appear to be less effective.14

Screening is important in three populations: neonates on mask ventilation, sedated or paralyzed patients on a ventilator, and persons who wear contact lenses.

Corneal abrasion, with subsequent Pseudomonas panophthalmitis, can occur in patients in neonatal intensive care units who are receiving continuous positive airway pressure ventilation. It is attributed to the pressure of the masks on the orbit.

15 Eye discharge in mask-ventilated neonates should prompt evaluation for corneal abrasion and infection.

A similar problem can occur in adults who are deeply sedated or receiving neuromuscular blocking agents while on a ventilator, because their protective corneal reflex is suppressed. The incidence of corneal abrasion in this population decreased from 18 to 4 percent when prophylactic lubricating ointment was administered every four hours.

16 Persons who wear contact lenses are at higher risk of developing abrasions that become infected and ulcerate (Figure 6). Soft, extended-wear lenses have been associated with a 10-fold to 15-fold increase in ulcerative keratitis.

17 Case reports and a nonsystematic review suggest that screening for corneal abrasions also may be needed after airbag deployment in automobile crashes.18,19

Source: https://www.aafp.org/afp/2004/0701/p123.html

Causes of Corneal Injuries – Nashville, TN

Corneal injuries

When the clear film that protects the front of your eye is damaged, it is referred to as a corneal injury. This condition is quite common, and can be caused by several different factors, including infections, ultraviolet light, and foreign bodies becoming trapped in the eye.

At Choate Eye Associates in Nashville, TN, we offer treatments for a variety of eye conditions, including corneal injuries and abrasions. Here, we discuss common causes of corneal injuries, and what you can do to treat the problem if it occurs.

Direct Injury

Corneal abrasions can occur anytime the outer layer of the cornea becomes scraped or scratched. You could sustain an injury if you poke yourself in the eye with your fingernail or another object, such as a pencil or makeup brush. Additionally, excessively rubbing your eye can lead to corneal injury.

Eye Infections

Bacterial, fungal, viral, or parasitical eye infections are often closely related to corneal injuries. For example, if you have herpes simplex keratitis, you are more ly to develop a corneal injury as a result.

In most cases, corneal abrasion occurs first, and then leads to an eye infection. Other causes of eye infections include extremely dry eyes, severe allergic eye disease, eyelids that cannot close completely, inflammatory disorders, and more.

Contact Lens Issues

Contact lenses are an excellent vision correction option. However, they can cause painful issues if they are not cared for properly.

For example, many soft contact lenses are supposed to be removed before sleeping. If they remain in your eyes overnight, it can result in corneal ulcers, abrasions, and infections.

Some patients are simply more sensitive to contact lenses. Therefore, it is important to exercise proper care and caution when handling, cleaning, and storing them.

Foreign Bodies

If the eyes are exposed to a foreign substance such as sand, dirt, or dust, these particles can scratch the outer layer of the cornea.

The natural reaction when a foreign body becomes stuck under your eyelid is to rub your eye. Try not to do this. Instead, blink multiple times, and rinse your eye with sterile saline or clean water.

If this does not work, you can gently pull your upper eyelid over the lower lid. This can sometimes help dislodge the particle.

Chemical Injuries

Nearly any chemical that comes in contact with your eye can lead to serious damage, including disfigurement or visual impairment. If you have experienced an eye injury due to a chemical splash, contact a medical professional right away. This type of injury can be extremely dangerous; early treatment gives you the most optimal chance of a successful outcome.

Ultraviolent Injuries

Sometimes referred to as corneal flash burns, ultraviolet injuries occur from overexposure to UV radiation. This could be caused by direct sunlight, flood lamps, sun lamps, welders’ arcs, and even certain halogen light bulbs.

This condition is often described as a sunburn on the eyes. It can lead to discomfort, changes in vision, or total vision loss. To prevent this type of injury, it is important to wear protective eyewear whenever necessary.

Learn More about Corneal Injuries

If you suspect you have a corneal injury or abrasion, schedule a consultation with Dr. Choate today. He can help you determine an effective treatment plan for your situation, and can recommend ways to avoid the problem again in the future. You can contact us online anytime or call our office at (615) 851-7575.

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Source: https://www.choateeye.com/blog/2017/12/28/exploring-the-causes-of-corneal-188137

Corneal Trauma / Injury

Corneal injuries

Corneal injury describes an injury to the cornea. The cornea is the crystal clear (transparent) tissue covering the front of the eye. It works with the lens of the eye to focus images on the retina.

Injuries to the cornea are common. Injuries to the outer surface of the cornea, called corneal abrasions, may be caused by:

  • Chemical irritation – from almost any fluid that gets into the eye
  • Overuse of contact lenses or lenses that don't fit correctly
  • Reaction or sensitivity to contact lens solutions and cosmetics
  • Scratches or scrapes on the surface of the cornea (called an abrasion)
  • Something getting into the eye (such as sand or dust)
  • Sunlight, sun lamps, snow or water reflections, or arc-welding
  • Infections may also damage the cornea

You are more ly to develop a corneal injury if you:

  • Are exposed to sunlight or artificial ultraviolet light for long periods of time
  • Have ill-fitting contact lenses or overuse your contact lenses
  • Have very dry eyes
  • Work in a dusty environment
  • High-speed particles, such as chips from hammering metal on metal, may become embedded in the surface of the cornea. Rarely, they may pass through the cornea and go deeper into the eye.

Treatment

DO NOT try to remove an object that is stuck in your eye without professional medical help.

If chemicals are splashed in the eye, IMMEDIATELY flush the eye with water for 15 minutes. The person should be quickly taken to the nearest emergency room.

Anyone with severe eye pain needs to be evaluated in an emergency care center or by an eye specialist immediately.
Treatment for corneal injuries may involve:

  • Removing any foreign material from the eye
  • Wearing an eye patch or temporary bandage contact lens
  • Using eye drops or ointments prescribed by the doctor
  • Not wearing contact lenses until the eye has healed
  • Taking pain medicines

Outlook (Prognosis)

Injuries that affect only the surface of the cornea normally heal very quickly with treatment. The eye should be back to normal within 2 days.

Injuries that penetrate (go through) the cornea are much more serious. The outcome depends on the specific injury and if it is treated timely.

When to Contact a Medical Professional

Call your health care provider if the injury has not significantly improved in 2 days with treatment.

Prevention

  • Wear safety goggles at all times when using hand or power tools or chemicals, during high impact sports, or in other situations where you may get an eye injury.
  • Wear sunglasses that screen ultraviolet light when you are exposed to sunlight, even during the winter.
  • Be careful when using household cleaners. Many household products contain strong acids, alkalis, or other chemicals. Drain and oven cleaners are particularly dangerous. They can lead to blindness if not used correctly.

Source: http://www.leeeyecenter.com/corneal-trauma-injury.htm

Corneal Abrasion: Practice Essentials, Background, Anatomy

Corneal injuries

Potential causes of corneal abrasion include the following:

  • Injury (eg, fingers, fingernails, paper, mascara brushes, tree branches, self-inflicted rubbing, pepper-spray exposure, [4] automotive frontal air bags [5] )
  • Blowing dust, sand, or debris
  • Extended contact lens wear
  • Ocular foreign bodies embedded under an eyelid
  • Iatrogenic – Unconscious patients, accidental injury by health care workers, improper eyelid patching in patients with Bell palsy, and other neuropathies in which the eyelid cannot be closed voluntarily
  • Thermal burns, such as cigarette and match burns
  • UV keratitis – History of exposure to electric arc welding or tanning beds without proper eye protection, history of prolonged exposure to bright sunlight without sunglasses (eg, snow blindness)
  • Eyelid margin injuries,  avulsions, and malpositions
  • Punctal and canalicular lacerations

In persons with trachoma, the constant corneal trauma by aberrant lashes and inadequate tears can produce corneal erosions, ulceration, and scarring. These constitute the major pathway to blindness in trachoma.

Contact lens–induced epithelial defects or direct trauma during lens insertion or removal can cause corneal abrasions.

Abrasions occur more frequently with rigid lenses than with other lenses, possibly because of their small diameter and the sharp corneal defects they cause.

Rigid contact lenses can lead to relative corneal hypoxia, epithelial edema, and epithelial breakdown. Corneal abrasions due to soft lenses are observed most frequently with tight or extended-wear lenses.

In these situations, acute epithelial hypoxia impairs attachment of the epithelium to the Bowman membrane.

The most common trauma is an inferior abrasion of the cornea caused by lens removal. Sometimes, the person's fingernail slices the contact lens and also the cornea. More often, the lens becomes slightly dehydrated at the end of the day because of insufficient blinking. The lens adheres to the cornea, removing the epithelium.

This area may not heal well, especially if the epithelial cells are continually torn away. After the contact lens is removed, the patient may feel discomfort; however, no pain occurs when the lens is worn because it acts as a bandage.

Patients who incompletely blink and those who work in a dry environment, read most of the day, or look at TV or computer screens should be warned about this complication.

A foreign body may become trapped under a contact lens and produce linear scratch marks on the cornea. The total irregularity of these wavy abrasions is the clue to this cause of injury.

A soft lens offers no protection against blunt trauma to the eye, but it does not pose any additional jeopardy in terms of eye trauma. For example, a soft lens does not adversely affect an eye injured by a fist or a ball. In industrial settings, a soft lens is not a substitute for safety glasses.

Rigid contact lenses may break or chip, causing punctate epithelial keratopathy.

Adverse corneal events, such as corneal abrasions, have been reported with techniques of overnight corneal reshaping with orthokeratology. Lang concluded that corneal compromise and poor compliance can cause adverse events with corneal reshaping. [6] The need for ongoing patient education is important in both children and adults who wear contact lenses.

Corneal abrasions can occur in almost all sports. They most frequently occur in young people.

In places where soccer is played frequently, impact with the soccer ball causes approximately one third of all sports-related eye injuries.

Contrary to previous ophthalmologic teaching that balls larger than 4 inches in diameter rarely cause eye injury, 8.

6-inch soccer balls cause most soccer-related eye injuries, both serious (eg, hyphema, vitreous hemorrhage, retinal tear, chorioretinal rupture, angle recession) and minor (eg, corneal abrasions, contusions). [7]

Approximately 1 in 10 college basketball players has an eye injury each year. Most basketball-related eye injuries are corneal abrasions caused by an opponent's finger or elbow striking the player's eye.

The incidence of severe eye injuries in wrestling is low. In a study at Michigan State University, 18.

4% of wrestlers had eye injuries that were relatively mild (eg, lacerated eyebrows, corneal abrasions) and that left no permanent damage.

[8] The average college team with 25 players and 2600 athlete exposures should expect 1-2 eye injuries each season, with a significant injury every 9-10 seasons. [9]

Although significant eye injuries are not a major risk in equestrian events other than polo, cross-country riders frequently have corneal abrasions from hitting tree branches overhanging the trail. Wearing spectacles with polycarbonate lenses provides adequate protection against this risk.

Although cross-country skiing causes fewer musculoskeletal injuries than alpine skiing, cross-country skiers are more ly than alpine skiers to have eye injuries, especially corneal abrasions from contact with tree twigs. [10] In addition, both cross-country and downhill skiers can have solar keratopathy (snow blindness) and injuries due to accidents with ski poles.

In patients undergoing eyelid surgery, corneal abrasion can result from sutures inadvertently placed through the tarsus or conjunctival surface. After sutures are placed, the lid should be everted to check that they are not exposed.

The globe and cornea should be protected during lid dissection and suture placement. A contact lens corneal protector or lid plate can be used.

General anesthesia is more ly to cause adverse systemic effects than local or ocular complications. Ocular problems that do occur are usually not serious and include corneal abrasion, chemical keratitis, hemorrhagic retinopathy, and retinal ischemia (rare).

The incidence of corneal abrasion due to general anesthesia is as high as 44%.

Simple precautions, such as instilling a bland ointment or taping both pairs of eyelids closed in the case of nonocular surgery and the lids of the nonoperative eye in the case of ocular surgery, may prevent surface trauma produced by the surgical drape, anesthetic mask, or exposure and drying of the cornea. Decreased tear production under general anesthesia, proptosis, and a poor Bell phenomenon may worsen corneal exposure, requiring eyelid suturing in some susceptible patients.

Corneal abrasion is one of the complications of argon laser trabeculoplasty. Others include the following [11] :

  • Acutely elevated intraocular pressure (IOP)
  • Progressive visual field loss
  • Peripheral anterior synechiae
  • Sector palsy of the pupillary sphincter

The applanation instrument can cause corneal abrasion if the eye or tonometer moves during measurement. In addition, if the disinfectant solution (eg, alcohol) is not removed from the surface of the tonometer, it can cause a circular toxic keratitis where it touches the cornea.

The Schiøtz tonometer must be used in the supine position or in the sitting position with the head back far enough to be horizontal. An initial blink or avoidance reaction may occur as the patient sees the tonometer descending toward the eye. The metal plate of the tonometer or the plunger may abrade the cornea.

Source: https://emedicine.medscape.com/article/1195402-overview

Corneal injuries

Corneal injuries

The cornea is the transparent dome at the front of the eye that covers the pupil and the iris (the coloured part of the eye). Injuries to the cornea are common, and may include abrasions (scratches), lacerations (jagged cuts) or wounds from foreign bodies.

Causes of corneal injuries

Corneal abrasions are commonly caused by eye rubbing, fingernails, tree branches, thrown objects and contact lenses. Lacerations are frequently caused by sharp objects such as pencils or screwdrivers. Foreign bodies may include dirt, wood, metal or glass fragments.

Symptoms of corneal injuries

Symptoms may include:

  • watering and irritation of the eye;
  • a feeling that there is something in the eye;
  • pain in the eye;
  • blurred vision; and
  • sensitivity to light.

Most of these injuries are relatively minor, and with the correct treatment will heal without any significant long-term problems.

Occasionally, however, injuries, especially those from sharp foreign bodies at high speed, may extend into the deeper layers of the eye. These penetrating eye injuries are more serious and may potentially result in loss of vision in that eye.

Foreign bodies that are retained in the cornea can cause infection and retained metal fragments can cause persistent inflammation and long term defects in the corneal surface if they are not treated.

Diagnosis

Firstly, your vision will be checked, and then your doctor will carry out an eye examination. A slit lamp microscope or other magnifying instrument is generally used.

Eye drops containing a dye (fluorescein) may be used to help make corneal injuries show up more easily.

If a penetrating eye injury or foreign body within the eye is suspected, immediate referral to an ophthalmologist (eye specialist) is required and a CT or MRI scan may be requested.

Treatment of corneal injuries

Corneal abrasions are often treated with an antibiotic eye ointment or eye drops for several days to prevent infection. The doctor will need to follow you up to check that the wound has healed and that your vision is all right.

If a corneal foreign body is detected, eye drops are used to numb the surface of the eye so that the foreign body can be removed. In addition to topical antibiotics, a cycloplegic eye drop may also be used. This prevents painful spasm of the muscles which constrict the pupil.

Metallic foreign bodies may leave behind a ‘rust ring’, which will need to be removed under topical (local) anaesthesia, possibly by an ophthalmologist.

Sometimes an eye pad is applied for comfort whilst the abrasion is healing. If this is the case, it is important you do not drive whilst wearing it.

Contact lens wearers may be advised to discontinue their use of the lenses temporarily whilst the abrasion is healing. Your doctor will advise how long you need to do this for.

References

1.Eye trauma: corneal foreign body or corneal abrasion. [Revised 2008 Feb]. In: eTG complete [Internet]. Melbourne: Therapeutic Guidelines Limited; 2012 Nov. http://online.tg.org.au/complete/ (Accessed Dec 2012).2.NSW Department of Health. Eye Emergency Manual: An Illustrated Guide.

2nd Edition, 2009. [Internet] http://www.aci.health.nsw.gov.au/_data/assets/pdf_file/0013/155011/eye_manual.pdf#zoom=100 (Accessed Dec 2012)

3.MedlinePlus. Corneal injury. [Internet]. Last updated Sept 2012. http://www.nlm.nih.gov/medlineplus/ency/article/001017.htm (Accessed Dec 2012).

Source: https://www.mydr.com.au/eye-health/corneal-injuries

Corneal Abrasion: Healing Time, Treatment, Causes, and More

Corneal injuries

A corneal abrasion is a scratch on your eye. It can happen in an instant. You poke your eye or something gets trapped under your eyelid, dirt or sand. Your eye hurts, and it doesn’t get better when you close it — if you can keep it shut. Light makes it sting and burn.

It’s actually on your cornea. That’s the clear layer that covers the iris, the colored part of your eye. It also shields the pupil — the black circle in the middle of your eye.

You might get a scratch if you:

  • Poke your eye with a fingernail, pen, or makeup brush
  • Get dirt, sand, sawdust, ash, or some other foreign matter in your eye
  • Get chemicals in your eye
  • Rub it too hard
  • Wear poor-fitting or dirty contact lenses
  • Get a certain type of eye infection
  • Have surgery without proper eye protection
  • Play sports or engage in high-risk physical activity without safety eyewear
  • Overwear your contact lenses

You may not feel symptoms right away. As a result, you may not be able to figure out what caused it.

Yes. If you feel there’s something in your eye, you’re going to want to rub it. Don't — that’s how you get a scratch. Do this instead:

  • Blink your eye several times.
  • Pull your upper eyelid over the lower eyelid.
  • Gently rinse your eye out with clean water or a sterile saline solution.

Don’t try to remove anything that’s stuck onto your cornea. Only a doctor should do that.

If you still feel something’s in your eye, see an eye doctor as soon as you can or go to the emergency room. The doctor will look at your eye and use a product called eye stain that lets him see the surface of your cornea. If something is on it or in it, he can safely remove it.

If you've scratched your eye before, you’ll probably remember how it feels. If not, you might:

  • Feel you have sand or grit in your eye
  • Have pain, especially when you open or close your eye
  • Notice tearing and redness
  • Become sensitive to light
  • Have blurred vision

Your doctor may prescribe antibiotic eyedrops or ointment to keep your eye from getting infected. He might also give you medicated eyedrops to ease pain and redness, along with pain medicine. She might tape your eye shut and have you wear a patch over your eye to keep light from bothering it.

A minor scratch should heal on its own in 1 to 3 days. More severe abrasions may take longer.

While your eye heals:

  • Don’t rub your eye.
  • Don’t wear contacts until your eye doctor says it’s safe to do so.
  • Wear sunglasses to ease discomfort caused by sunlight.

You should fully recover from a minor scratch without permanent eye damage. But deep scratches can cause infections, scars, and other problems. If you don’t take care of them, they can lead to long-term vision problems. Report any unusual symptoms, including a return of pain after treatment, to your eye doctor.

SOURCES:

American Academy of Ophthalmology: “What Is Corneal Abrasion?”

American Academy of Family Physicians: “Corneal Abrasions.”

Cleveland Clinic: “Corneal Abrasions.”

UPMC: “Corneal Abrasions.”

National Eye Institute: “Facts About The Cornea and Corneal Disease.”

© 2017 WebMD, LLC. All rights reserved. Corneal Abrasion Treatment

Source: https://www.webmd.com/eye-health/corneal-abrasions

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