325:
eye examination, the doctor sees these deposits in the stroma as clear, comma-shaped overlapping dots and branching filaments, creating a lattice effect. Over time, the lattice lines will grow opaque and involve more of the stroma. They will also gradually converge, giving the cornea a cloudiness that may also reduce vision. In some people, these abnormal protein fibers can accumulate under the cornea's outer layer—the epithelium. This can cause erosion of the epithelium. This condition is known as recurrent epithelial erosion. These erosions: (1) Alter the cornea's normal curvature, resulting in temporary vision problems; and (2) Expose the nerves that line the cornea, causing severe pain. Even the involuntary act of blinking can be painful.
32:
321:
optical emergency as it is sight- (in some cases eye-) threatening. Contact lens wearers who present with corneal abrasions should never be pressure patched because it has been shown through clinical studies that patching creates a warm, moist dark environment that can cause the cornea to become infected or cause an existing infection to be greatly accelerated on its destructive path.
488:
Topical antibiotics are used to prevent concomitant infections, which result in slower healing of corneal abrasions. Ointments are considered the first-line treatment, as they are more lubricating than drops. If the person uses contact lenses, an antibiotic with anti-pseudomonal activity is preferred
381:
fit and the compliance of the person with care measures can prevent contact lens-related complications. As it has been stated previously, these can cause both mechanic damage to the cornea and be a risk factor for the development of microbial keratitis. Thus, an emphasis should be placed on reducing
368:
should be worn by people who work with hazardous machinery, metal, wood, or chemicals, as well as those who perform yard work or participate in certain contact sports. The appropriate type of protective eyewear depends on the specific circumstances, but all should provide shielding, good visibility,
320:
which forms in the eye's biofilm as a result of extended soft contact lens wear. When a corneal abrasion occurs either from the contact lens itself or another source, the injured cornea is much more susceptible to this type of bacterial infection than a non-contact lens user's would be. This is an
324:
Corneal abrasions are also a common and recurrent feature in people with specific types of corneal dystrophy, such as lattice corneal dystrophy. Lattice dystrophy gets its name from an accumulation of amyloid deposits, or abnormal protein fibers, throughout the middle and anterior stroma. During an
373:
glasses or goggles, plastic safety glasses, face shields, and welding helmets. Specifically, welders should use a helmet with a lens that blocks UV light to avoid UV keratitis. It is important to notice that people with one eye are especially vulnerable to potentially blinding injuries, and should
484:
are the most used, one drop four times a day. It is worth noting, however, that diclofenac may delay wound healing and ketorolac should be avoided in people who wear contact lenses. Some studies do not recommend using topical NSAIDs due to the risk of corneal toxicity. There is no direct evidence
311:
that have been left in too long. Damage may result when the lenses are removed, rather than when the lens is still in contact with the eye. In addition, if the cornea becomes excessively dry, it may become more brittle and easily damaged by movement across the surface.
382:
lens contamination by using effective disinfecting solutions, as well as antimicrobial contact lenses and cases. It is important to avoid swimming with contact lenses, because this increases the frequency of bacterial infections, primarily from
545:
is not generally recommended as they do not help with healing or pain. Furthermore, it can result in decreased oxygen delivery, increased moisture and a higher chance of an infection. Another measure that is no longer recommended is the use of
1049:
1034:
459:
Irrigation of the ocular surface and upper and lower fornices can be performed after the procedure to wash out any residual loose foreign body material. A 10 mL ampoule of sterile saline is usually sufficient.
388:
and other organisms found in contaminated water. Finally, people who use contact lenses can also avoid both mechanical and infectious trauma by not using contacts beyond the length of their intended use.
233:
About 3 per 1,000 people are affected a year in the United States. Males are more often affected than females. The typical age group affected is those in their 20s and 30s. Complications can include
422:
as far as possible, and reduces the chance of eliciting a blink reflex. If necessary, the eyelids can be kept open using an eyelid speculum, the examiner's fingertips, a cotton tip or an assistant.
374:
pay special attention to protecting their eyes. In these cases, protective eyewear can ensure some degree of safety while also allowing people to participate in their normal day-to-day activities.
514:
drops 4 times a day, and a fluoroquinolone ointment, typically ciprofloxacin, at night. If the abrasion was caused by another mechanism, the recommended treatment includes antibiotic ointments (
1130:
501:), and the use of contact lenses should be discontinued until the abrasion has healed and the antibiotic treatment has ended. This is because contact lens wearers are often colonized with
273:
Complications are the exception rather than the rule from simple corneal abrasions. It is important that any foreign body be identified and removed, especially if containing iron as
485:
regarding the use of oral analgesics, but because pain relief is the main concern for people with corneal abrasions, these are prescribed according to individual's characteristics.
913:
Puls HA, Cabrera D, Murad MH, Erwin PJ, Bellolio MF (November 2015). "Safety and
Effectiveness of Topical Anesthetics in Corneal Abrasions: Systematic Review and Meta-Analysis".
468:
Current recommendations stress the need to use topical and/or oral analgesia and topical antibiotics. One review has found that eye drops to numb the surface of the eye such as
397:
The treatment of corneal abrasions aims to prevent bacterial superinfection, speed healing, and provide symptomatic relief. If a foreign body is found, it needs to be removed.
265:, and often redness of the eye. The vision may be blurred, both from any swelling of the cornea and from excess tears. Crusty buildup from excess tears may also be present.
1123:
948:
Calder LA, Balasubramanian S, Fergusson D (May 2005). "Topical nonsteroidal anti-inflammatory drugs for corneal abrasions: meta-analysis of randomized trials".
1116:
414:
held in the non-dominant hand. The person is then asked to focus on a particular point on the ceiling so that the foreign body sits as centrally between the
444:
Removal techniques: There are mainly two types of techniques, the choice of which will depend on the nature of the foreign body. The first technique is the
472:
improve pain; however, their safety is unclear. Another review did not find evidence of benefit and concluded there was not enough data on safety. Topical
983:
878:
Swaminathan A, Otterness K, Milne K, Rezaie S (November 2015). "The Safety of
Topical Anesthetics in the Treatment of Corneal Abrasions: A Review".
352:. Injury following use of hammers or power-tools should always raise the possibility of a penetrating foreign body into the eye, for which urgent
510:
If the mechanism of injury involves contact lenses, fingernails or organic/ plant matter, antibiotic prophylaxis should be provided with topical
433:
0.4% is the preferred choice as it has an onset of action of 20 seconds and a half-life of 20 minutes. A drop of topical pupil dilator such a
783:
671:
316:
wear overnight has been extensively linked to gram negative keratitis (infection of the cornea) particularly by a bacterium known as
1272:
693:
473:
1001:
448:
removal, which is indicated in superficial foreign bodies with no surrounding corneal reaction, and the second is the
863:
777:
665:
31:
300:. Common causes include being poked by a finger, walking into a tree branch, and wearing old contact lenses. A
1108:
799:"Microbial contamination of contact lenses, lens care solutions, and their accessories: a literature review"
657:
Family Nurse
Practitioner Certification Intensive Review: Fast Facts and Practice Questions, Second Edition
406:
Positioning: The person is laid in a comfortable position with the affected eye closest to the physician.
410:
can be used if available and the eye can be illuminated with a medical light or, alternatively, with an
345:
stain that fills in the corneal defect and glows with a cobalt blue-light is generally instilled first.
384:
188:
1267:
559:
285:
1241:
619:
Ahmed F, House RJ, Feldman BH (September 2015). "Corneal
Abrasions and Corneal Foreign Bodies".
523:
503:
114:
767:
655:
341:
provide higher magnification which allow for a more thorough evaluation. To aid in viewing, a
1262:
846:
Fowler GC (2011), "Corneal
Abrasions and Removal of Corneal or Conjunctival Foreign Bodies",
437:
1%, if available, can be helpful to reduce ciliary spasm after removal of the foreign body.
1157:
511:
338:
456:
removal with which the complete foreign body and any surrounding rust ring can be removed.
8:
1053:
234:
1221:
855:
823:
798:
743:
718:
64:
57:
1058:
348:
A careful search should be made for any foreign body, in particular looking under the
1064:
984:"Corneal abrasions and corneal foreign bodies: Clinical manifestations and diagnosis"
965:
930:
895:
859:
828:
773:
748:
661:
636:
449:
313:
281:
161:
101:
70:
48:
957:
926:
922:
891:
887:
851:
818:
810:
738:
734:
730:
685:
628:
1093:
814:
207:
180:
175:
use or from fingernails. About 25% of cases occur at work. Diagnosis is often by
1096:
171:
Most cases are due to minor trauma to the eye such as that which can occur with
434:
411:
365:
334:
308:
219:
199:
133:
1138:
1069:
1043:
997:
961:
632:
1256:
1170:
507:, which may cause corneal perforations and subsequent permanent vision loss.
490:
430:
370:
353:
238:
184:
123:
119:
53:
280:
Occasionally the healed epithelium may be poorly adherent to the underlying
969:
934:
899:
832:
769:
Smolin and Thoft's The Cornea: Scientific
Foundations and Clinical Practice
752:
640:
531:
515:
378:
301:
227:
192:
172:
165:
257:, a foreign-body sensation, excessive squinting, and reflex production of
1140:
527:
445:
342:
254:
223:
211:
40:
1026:
364:
Prevention is the best method to avoid recurrence of corneal abrasions.
1195:
519:
494:
477:
469:
426:
418:
as possible. This accounts for a more sterile procedure by keeping the
297:
203:
429:
is instilled into both eyes in order to reduce blepharospasm. Topical
1190:
1180:
1088:
547:
498:
481:
176:
106:
550:, formerly used to relieve the pain caused by ciliary muscle spasm.
476:(NSAIDs) are useful to reduce the pain caused by corneal abrasions.
542:
438:
183:
has been applied. More significant injuries like a corneal ulcer,
419:
168:
is in the eye. Most people recover completely within three days.
226:
can help with pain. Evidence does not support the usefulness of
1038:
877:
441:
is generally avoided due to its long-lasting mydriatic effects.
415:
349:
242:
215:
153:
947:
796:
453:
407:
262:
258:
274:
304:
in the eye may also cause a scratch if the eye is rubbed.
1211:
157:
797:
Szczotka-Flynn LB, Pearlman E, Ghannoum M (March 2010).
660:(2 ed.). Springer Publishing Company. p. 112.
284:
in which case it may detach at intervals giving rise to
765:
912:
253:
Signs and symptoms of corneal abrasion include pain,
1016:
848:
Pfenninger and Fowler's
Procedures for Primary Care
772:. Lippincott Williams & Wilkins. p. 798.
307:Injuries can also be incurred by "hard" or "soft"
245:. Complications may occur in up to 10% of people.
766:Smolin G, Foster CS, Azar DT, Dohlman CH (2005).
618:
526:every 2 or 4 hours) or antibiotic drops, usually
1254:
16:Scratch to the surface of the cornea of the eye
1124:
369:and a comfortable fit. Some examples include
206:ointment. In those who wear contact lenses a
716:
333:Although corneal abrasions may be seen with
296:Corneal abrasions are generally a result of
723:The Cochrane Database of Systematic Reviews
1131:
1117:
998:"BestBets: Mydriatics in corneal abrasion"
614:
612:
610:
608:
606:
604:
602:
600:
598:
596:
594:
30:
822:
742:
712:
710:
592:
590:
588:
586:
584:
582:
580:
578:
576:
574:
261:. Signs include epithelial defects and
39:A corneal abrasion after staining with
1255:
845:
717:Lim CH, Turner A, Lim BX (July 2016).
707:
571:
1139:Nonmusculoskeletal injuries of head (
1112:
425:Anaesthetic and pupil dilator: Local
248:
653:
474:nonsteroidal anti-inflammatory drugs
195:within the eye should be ruled out.
143:3 per 1,000 per year (United States)
152:is a scratch to the surface of the
13:
856:10.1016/b978-0-323-05267-2.00066-2
160:. Symptoms include pain, redness,
43:, it is the green mark on the eye.
14:
1284:
1012:
915:The Journal of Emergency Medicine
880:The Journal of Emergency Medicine
230:for those with simple abrasions.
210:antibiotic is often recommended.
1004:from the original on 2008-09-02.
786:from the original on 2016-11-07.
674:from the original on 2016-11-07.
298:trauma to the surface of the eye
268:
990:
976:
941:
719:"Patching for corneal abrasion"
696:from the original on 2016-11-07
400:
198:Prevention includes the use of
1273:Disorders of sclera and cornea
927:10.1016/j.jemermed.2015.02.051
906:
892:10.1016/j.jemermed.2015.06.069
871:
850:, Elsevier, pp. 433–439,
839:
790:
759:
735:10.1002/14651858.CD004764.pub3
678:
647:
463:
202:. Treatment is typically with
96:Minor trauma, contact lens use
1:
564:
359:
815:10.1097/icl.0b013e3181d20cae
392:
328:
7:
950:Academic Emergency Medicine
537:
10:
1289:
692:. National Eye Institute.
557:
553:
385:Staphylococcus epidermidis
356:opinion should be sought.
286:recurrent corneal erosions
255:trouble with bright lights
189:recurrent erosion syndrome
1234:
1209:
1178:
1167:
1148:
1079:
1020:
962:10.1197/j.aem.2004.10.026
633:10.1016/j.pop.2015.05.004
560:Corneal ulcers in animals
291:
139:
129:
113:
100:
92:
84:
76:
63:
47:
38:
29:
24:
218:, and eye drops such as
1242:Penetrating head injury
377:Ensuring both a proper
164:, and a feeling like a
803:Eye & Contact Lens
524:bacitracin/polymyxin B
504:Pseudomonas aeruginosa
318:Pseudomonas aeruginosa
115:Differential diagnosis
339:slit lamp microscopes
235:bacterial keratitis
1222:Perforated eardrum
1080:External resources
686:"Corneal Abrasion"
366:Protective eyewear
249:Signs and symptoms
224:paralyse the pupil
179:examination after
58:emergency medicine
1250:
1249:
1230:
1229:
1106:
1105:
450:hypodermic needle
314:Soft contact lens
282:basement membrane
214:(acetaminophen),
162:light sensitivity
147:
146:
102:Diagnostic method
71:light sensitivity
19:Medical condition
1280:
1268:Injuries of head
1201:Corneal abrasion
1176:
1175:
1133:
1126:
1119:
1110:
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843:
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826:
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787:
763:
757:
756:
746:
714:
705:
704:
702:
701:
682:
676:
675:
654:Leik MT (2013).
651:
645:
644:
616:
150:Corneal abrasion
88:Less than 3 days
34:
25:Corneal abrasion
22:
21:
1288:
1287:
1283:
1282:
1281:
1279:
1278:
1277:
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1252:
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1101:
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1029:
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1010:
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996:
995:
991:
982:
981:
977:
946:
942:
911:
907:
876:
872:
866:
844:
840:
795:
791:
780:
764:
760:
729:(7): CD004764.
715:
708:
699:
697:
684:
683:
679:
668:
652:
648:
617:
572:
567:
562:
556:
540:
534:4 times a day.
512:fluoroquinolone
466:
403:
395:
362:
335:ophthalmoscopes
331:
294:
271:
251:
208:fluoroquinolone
181:fluorescein dye
20:
17:
12:
11:
5:
1286:
1276:
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1265:
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1128:
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1084:
1083:
1081:
1077:
1076:
1073:
1072:
1061:
1046:
1030:
1025:
1024:
1022:
1021:Classification
1014:
1013:External links
1011:
1008:
1007:
989:
975:
940:
905:
870:
864:
838:
789:
778:
758:
706:
677:
666:
646:
569:
568:
566:
563:
558:Main article:
555:
552:
539:
536:
465:
462:
461:
460:
457:
442:
435:cyclopentolate
423:
402:
399:
394:
391:
361:
358:
330:
327:
309:contact lenses
293:
290:
270:
267:
250:
247:
220:cyclopentolate
200:eye protection
145:
144:
141:
137:
136:
134:Eye protection
131:
127:
126:
117:
111:
110:
104:
98:
97:
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90:
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81:
78:
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61:
60:
51:
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44:
36:
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27:
26:
18:
15:
9:
6:
4:
3:
2:
1285:
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1199:
1197:
1194:
1192:
1189:
1188:
1186:
1184:
1182:
1177:
1174:
1172:
1171:facial trauma
1168:Extracranial/
1166:
1160:
1159:
1154:
1153:
1151:
1147:
1142:
1134:
1129:
1127:
1122:
1120:
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1111:
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1028:
1023:
1019:
1003:
999:
993:
985:
979:
971:
967:
963:
959:
956:(5): 467–73.
955:
951:
944:
936:
932:
928:
924:
921:(5): 816–24.
920:
916:
909:
901:
897:
893:
889:
885:
881:
874:
867:
865:9780323052672
861:
857:
853:
849:
842:
834:
830:
825:
820:
816:
812:
809:(2): 116–29.
808:
804:
800:
793:
785:
781:
779:9780781742061
775:
771:
770:
762:
754:
750:
745:
740:
736:
732:
728:
724:
720:
713:
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695:
691:
687:
681:
673:
669:
667:9780826134257
663:
659:
658:
650:
642:
638:
634:
630:
627:(3): 363–75.
626:
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601:
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593:
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544:
535:
533:
529:
525:
521:
517:
513:
508:
506:
505:
500:
496:
492:
491:ciprofloxacin
486:
483:
479:
475:
471:
458:
455:
451:
447:
443:
440:
436:
432:
431:oxybuprocaine
428:
424:
421:
417:
413:
412:ophtalmoscope
409:
405:
404:
398:
390:
387:
386:
380:
375:
372:
371:polycarbonate
367:
357:
355:
354:ophthalmology
351:
346:
344:
340:
336:
326:
322:
319:
315:
310:
305:
303:
299:
289:
287:
283:
278:
276:
269:Complications
266:
264:
260:
256:
246:
244:
240:
239:corneal ulcer
236:
231:
229:
225:
221:
217:
213:
209:
205:
201:
196:
194:
190:
186:
185:globe rupture
182:
178:
174:
169:
167:
163:
159:
155:
151:
142:
138:
135:
132:
128:
125:
124:globe rupture
121:
120:Corneal ulcer
118:
116:
112:
108:
105:
103:
99:
95:
91:
87:
83:
79:
75:
72:
68:
66:
62:
59:
55:
54:Ophthalmology
52:
50:
46:
42:
37:
33:
28:
23:
1263:Eye diseases
1210:
1200:
1179:
1155:
1149:Intracranial
1087:
1063:
1048:
1033:
992:
978:
953:
949:
943:
918:
914:
908:
886:(5): 810–5.
883:
879:
873:
847:
841:
806:
802:
792:
768:
761:
726:
722:
698:. Retrieved
689:
680:
656:
649:
624:
621:Primary Care
620:
543:Eye patching
541:
532:trimethoprim
516:erythromycin
509:
502:
487:
467:
401:Foreign body
396:
383:
379:contact lens
376:
363:
347:
332:
323:
317:
306:
302:foreign body
295:
279:
277:will occur.
272:
252:
232:
228:eye patching
197:
193:foreign body
173:contact lens
170:
166:foreign body
149:
148:
1235:Either/both
1158:neurotrauma
1141:head injury
690:nei.nih.gov
528:polymyxin B
464:Medications
427:anaesthetic
343:fluorescein
212:Paracetamol
77:Usual onset
41:fluorescein
1257:Categories
1196:Eye injury
1143:) and neck
1065:DiseasesDB
700:2016-11-06
565:References
548:mydriatics
520:bacitracin
495:gentamicin
478:Diclofenac
470:tetracaine
446:cotton tip
360:Prevention
204:antibiotic
130:Prevention
69:Eye pain,
1191:Black eye
1097:emerg/828
1089:eMedicine
499:ofloxacin
482:ketorolac
420:eyelashes
393:Treatment
329:Diagnosis
177:slit lamp
140:Frequency
107:Slit lamp
49:Specialty
1002:Archived
970:15860701
935:26472608
900:26281814
833:20168237
784:Archived
753:27457359
694:Archived
672:Archived
641:26319343
538:Patching
452:or nº15
439:Atropine
191:, and a
85:Duration
65:Symptoms
1094:oph/247
824:3482476
744:6457868
554:Animals
416:eyelids
350:eyelids
275:rusting
156:of the
968:
933:
898:
862:
831:
821:
776:
751:
741:
664:
639:
408:Loupes
292:Causes
243:iritis
241:, and
216:NSAIDs
154:cornea
93:Causes
1059:918.1
1044:S05.0
454:blade
263:edema
259:tears
222:that
80:Rapid
1156:see
1070:3108
1054:9-CM
966:PMID
931:PMID
896:PMID
860:ISBN
829:PMID
774:ISBN
749:PMID
727:2016
662:ISBN
637:PMID
530:and
480:and
109:exam
1212:ear
1181:eye
1050:ICD
1035:ICD
958:doi
923:doi
888:doi
852:doi
819:PMC
811:doi
739:PMC
731:doi
629:doi
522:or
497:or
158:eye
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807:36
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709:^
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573:^
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237:,
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122:,
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1027:D
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