Ophthalmology Book

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Corneal Abrasion

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  1. Etiology
    1. Eye Trauma (foreign body)
    2. Extensive UV Light Exposure (Sunlamp, welder's arc)
  2. Symptoms
    1. Eye Pain (exacerbated by eye movement)
    2. Photophobia
    3. Foreign body sensation (or gritty sensation)
    4. Excessive eye tearing
    5. Blurred vision
    6. Headache
    7. Blepharospasm
  3. Signs
    1. Penlight exam
      1. Oblique illumination of the Cornea
        1. Irregularity in normally smooth, glistening surface
      2. Direct illumination of the Cornea
        1. Shadow on surface of iris
        2. Shadow moves opposite direction of light source
      3. Observe for foreign body
        1. Rust rings and foreign bodies must be removed
    2. Fluorescein exam (with cobalt blue light)
  4. Differential Diagnosis
    1. Corneal Ulcer
    2. Retained Corneal Foreign Body
    3. Herpes Simplex Keratitis
  5. Management
    1. Rule-out Retained Foreign Body in Cornea or upper lid
    2. Do not wear contacts until lesion fully healed
    3. Topical Antibiotics
      1. General
        1. Ointments are more lubricating than drops
          1. Some have suggested that ointments delay healing
        2. Continue antibiotic for at least 48 hours
        3. Use anti-pseudomonal agent for complicated cases
          1. Contact lens related Corneal Trauma
      2. Standard agents
        1. Bacitracin 500 units/gram ointment 1/2 inch bid-qid
        2. Erythromycin 0.5% ointment 1/2 inch ribbon bid-qid
      3. Extended spectrum agents (Anti-Pseudomonal agents)
        1. Ciprofloxacin 0.3% solution 2 drops q1-4 hours
        2. Gentamycin 0.3% ointment 1/2 inch bid-tid
          1. May be toxic to Corneal Epithelium
        3. Ofloxacin 0.3% solution 2 drops q1-4 hours
        4. Tobramycin
      4. Other agents
        1. Chloramphenicol 1% ointment 2 drops q3 hours
          1. Reduces risk of Corneal Ulcer
          2. Upadhyay (2001) Br J Ophthalmol 85:388
    4. Analgesics
      1. Topical NSAIDS (may delay healing time)
        1. Diclofenac (Voltaren) 0.1% solution in eye qid prn
        2. Ketorolac (Acular) 0.5% solution in eye qid prn
      2. Oral Analgesics
        1. NSAIDs
        2. Vicodin
    5. Options to avoid
      1. Avoid home prescription of topical anesthetic
        1. Delays re-epithelialization
        2. Suppresses normal blink reflex
      2. Mydriatics no longer recommended
        1. Dilating drops were used to decrease ciliary spasm
        2. Examples: Cyclogyl or 0.25% Isopto Hyoscine
      3. Pressure Patch no longer recommended
        1. Adverse effects
          1. Delays healing process
          2. Exacerbates Eye Pain
          3. Interferes with routine activities
          4. Severe anaerobic infections in contact wearers
          5. Le Sage (2001) Ann Emerg Med 28:129
        2. Technique (listed for historical purposes)
          1. Apply 3-5, 1 inch tape strips
          2. Superior end over medial forehead
          3. Inferior end over lateral cheek
  6. Complications
    1. Recurrent Corneal Erosion (10%)
      1. Spontaneous sudden Eye Pain weeks after healing
      2. Refer to ophthalmology
      3. Lubricant drops during day and ointment at night
    2. Secondary infection
    3. Corneal Ulcer
  7. Course
    1. Small uncomplicated abrasion heals in 3-4 days
    2. Large abrasions (involve 50% of Cornea) heal in 5 days
    3. Recurrent symptoms may persist for 3 months
  8. Follow-up
    1. Second visit at 24 hours, examine for
      1. Healing
      2. Signs infection
      3. Corneal Ulcer
      4. Missed foreign body
    2. Third visit at 3-4 days in contact lens wearers
      1. Observe for Corneal Ulcer or infection
    3. Referral to Ophthalmology for:
      1. Large or deep abrasions
      2. Suspected Herpes Keratitis
      3. Abrasion edge is gray or white suggesting infection
      4. Suspected recurrent Corneal Erosion
      5. Corneal Ulcer or infection (haze at abrasion)
      6. Continued pain after 48 hours
      7. Inadequate healing by 72 hours
      8. Retained Foreign Body
  9. Prevention
    1. See Eye Protection
    2. Careful fitting, placement and care of contact lenses
    3. Keep Fingernails short
    4. Perioperative Corneal abrasion risk (lag-ophthalmos)
      1. Tape eyelids closed during surgery or
      2. Instill aqueous gels or soft contacts
    5. Ventilated and sedated patients in ICU
      1. Remove all contact lenses
      2. Use lubricating ointment q4 hours
  10. References
    1. Wilson (2004) Am Fam Physician 70:123

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