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Ophthalmology – Corneal Abrasion
A corneal abrasion is a defect in the corneal epithelium, most commonly caused by trauma, though it can also occur due to underlying epithelial adhesion problems or corneal dystrophies. It is one of the most frequent ophthalmic presentations and is typically very painful despite being a superficial injury.
The most common cause is mechanical trauma, such as fingernails, paper cuts, foreign bodies, or contact lenses. Contact lens wearers and individuals in high-risk occupations (e.g., construction, welding) are particularly vulnerable. Nontraumatic causes include recurrent corneal erosion, often due to poor adhesion between the epithelium and underlying basement membrane, especially after prior injury or in conditions like map-dot-fingerprint dystrophy.
Patients usually present with sudden onset of severe eye pain, foreign body sensation, redness, tearing, and photophobia. Pain typically worsens with blinking and improves when the eye is closed. Many patients can clearly recall the inciting event. In recurrent cases, symptoms often occur upon awakening, when the eyelid disrupts loosely adherent epithelium.
Diagnosis is confirmed with fluorescein staining under cobalt blue light, which highlights the epithelial defect as a bright green area. The abrasion is typically irregular in shape, and its size should be documented for follow-up. Vertical linear staining suggests a foreign body under the upper eyelid, which must be ruled out by lid eversion. The underlying corneal stroma should remain clear—any infiltrate raises concern for infection.
Management focuses on pain control, prevention of infection, and promoting healing. First-line treatment includes topical antibiotic drops or ointment (e.g., erythromycin or fluoroquinolones) to prevent secondary infection. Ointments provide better lubrication and comfort. Topical NSAIDs and cycloplegics can be used for pain and photophobia. Importantly, topical anesthetics must never be prescribed for home use, as they delay healing and can cause serious complications.
For recurrent corneal erosions, long-term therapy with lubricating drops, ointments, and hypertonic saline (e.g., 5% NaCl) helps improve epithelial adhesion. In refractory cases, procedures such as anterior stromal puncture or phototherapeutic keratectomy (PTK) may be considered.
Patching is generally not required for small abrasions and should be avoided if infection is suspected, especially in contact lens wearers, where the risk of bacterial keratitis is higher. Contact lenses should not be worn until complete healing occurs.
The prognosis is excellent, with most abrasions healing within 24–72 hours. However, complications can occur if untreated or mismanaged, including infectious keratitis, corneal ulceration, and recurrent erosions. Close follow-up is essential until the epithelial defect has fully healed.
A corneal abrasion is a defect in the corneal epithelium, most commonly caused by trauma, though it can also occur due to underlying epithelial adhesion problems or corneal dystrophies. It is one of the most frequent ophthalmic presentations and is typically very painful despite being a superficial injury.
The most common cause is mechanical trauma, such as fingernails, paper cuts, foreign bodies, or contact lenses. Contact lens wearers and individuals in high-risk occupations (e.g., construction, welding) are particularly vulnerable. Nontraumatic causes include recurrent corneal erosion, often due to poor adhesion between the epithelium and underlying basement membrane, especially after prior injury or in conditions like map-dot-fingerprint dystrophy.
Patients usually present with sudden onset of severe eye pain, foreign body sensation, redness, tearing, and photophobia. Pain typically worsens with blinking and improves when the eye is closed. Many patients can clearly recall the inciting event. In recurrent cases, symptoms often occur upon awakening, when the eyelid disrupts loosely adherent epithelium.
Diagnosis is confirmed with fluorescein staining under cobalt blue light, which highlights the epithelial defect as a bright green area. The abrasion is typically irregular in shape, and its size should be documented for follow-up. Vertical linear staining suggests a foreign body under the upper eyelid, which must be ruled out by lid eversion. The underlying corneal stroma should remain clear—any infiltrate raises concern for infection.
Management focuses on pain control, prevention of infection, and promoting healing. First-line treatment includes topical antibiotic drops or ointment (e.g., erythromycin or fluoroquinolones) to prevent secondary infection. Ointments provide better lubrication and comfort. Topical NSAIDs and cycloplegics can be used for pain and photophobia. Importantly, topical anesthetics must never be prescribed for home use, as they delay healing and can cause serious complications.
For recurrent corneal erosions, long-term therapy with lubricating drops, ointments, and hypertonic saline (e.g., 5% NaCl) helps improve epithelial adhesion. In refractory cases, procedures such as anterior stromal puncture or phototherapeutic keratectomy (PTK) may be considered.
Patching is generally not required for small abrasions and should be avoided if infection is suspected, especially in contact lens wearers, where the risk of bacterial keratitis is higher. Contact lenses should not be worn until complete healing occurs.
The prognosis is excellent, with most abrasions healing within 24–72 hours. However, complications can occur if untreated or mismanaged, including infectious keratitis, corneal ulceration, and recurrent erosions. Close follow-up is essential until the epithelial defect has fully healed.
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