Corneal abrasion

Determine how the injury was caused. In particular rule out chemical injury and penetrating trauma

Evaluate abrasion using fluorescein

size (use length of slit beam) and location
depth
edge quality
oedema beneath abrasion
confirm no corneal foreign body present
- presence of vegetative matter in abrasion increases risk of
  fungal infection.

If corneal foreign body present, see Clinical Management Guideline on Corneal Foreign Body
Evaluate anterior chamber reaction.
Evert eyelids to confirm no foreign body present.
If sub-tarsal foreign body present, see Clinical Management Guideline on Sub-Tarsal Foreign Body
Advise patient to return/seek further help if symptoms persist (potential for development of Recurrent Epithelial Erosion Syndrome (see CMG on Recurrent Epithelial Erosion Syndrome).
Advise on suitable eye protection.
(GRADE*: Level of evidence=low, Strength of recommendation=strong)

For large abrasions, consider therapeutic (bandage) contact lens fitting by optometrist
(or refer to HES).
(GRADE*: Level of evidence=low, Strength of recommendation=weak)

Do not patch or pad eye.
(GRADE*: Level of evidence=high, Strength of recommendation=strong)

Topical anaesthetic (e.g. gutt. proxymetacaine 0.5% or gutt. oxybuprocaine 0.4%) if necessary to aid examination.
Systemic analgesia for first 24h if necessary (e.g. ibuprofen, or paracetamol if contraindicated).
(GRADE*: Level of evidence=low, Strength of recommendation=strong)

Ocular lubricants for symptomatic relief (drops as needed for use during the
day, unmedicated ointment for use at bedtime).
(GRADE*: Level of evidence=low, Strength of recommendation=strong)

For large epithelial defects, cycloplegia to prevent pupil spasm (e.g. gutt cyclopentolate 1% twice daily until healed)
(GRADE*: Level of evidence=low, Strength of recommendation=weak)

If there is a possibility of infection, prescribe a broad spectrum topical antibiotic e.g. gutt chloramphenicol 0.5% or 1.0% ointment (NB risk of infection following mild trauma is low and the beneficial effects of antibiotic prophylaxis in preventing ocular infection or accelerating epithelial healing following a corneal abrasion remain unclear).
(GRADE*: Level of evidence=low, Strength of recommendation=weak)

In the case of contact lens wearers, antibiotic prophylaxis should be with a drug effective against Gram -ve organisms, e.g. a quinolone such as levofloxacin or moxifloxacin, or an aminoglycoside such as gentamicin. Contact lenses should not be worn during the treatment period.
(GRADE*: Level of evidence = low, Strength of recommendation = strong).

Topical NSAID for its analgesic and anti-inflammatory properties, e.g. gutt. diclofenac 0.1%.
(RCTs do not provide strong evidence to support their use)
(GRADE*: Level of evidence=moderate, Strength of recommendation=weak)

For large abrasions or in associated iritis, consider cycloplegia to alleviate ciliary spasm, (e.g. gutt. cyclopentolate 1% twice daily until healed).
(GRADE*: Level of evidence=low, Strength of recommendation=weak)

Evidence base

*GRADE: Grading of Recommendations Assessment, Development and Evaluation (www.gradingworkinggroup.org)

Sources of evidence

Algarni AM, Guyatt GH, Turner A, Alamri S. Antibiotic prophylaxis for corneal abrasion. Cochrane Database Syst Rev. 2022;5(5):CD014617.

Corneal Abrasions. BMJ Best Evidence 2021

Lim CH, Turner A, Lim BX. Patching for corneal abrasion. Cochrane Database Syst Rev. 2016;7:CD004764

Meek R, Sullivan A, Favilla M, Larmour I, Guastalegname S. Is homatropine 5% effective in reducing pain associated with corneal abrasion when compared with placebo? A randomized controlled trial. Emerg Med Australas.2010;22(6):507-13

Wakai A, Lawrenson JG, Lawrenson AL, Wang Y, Brown MD, Quirke M, Ghandour O, McCormick R, Walsh CD, Lang E, Amayem A. Topical nonsteroidal anti-inflammatory drugs for analgesia in traumatic corneal abrasions. Cochrane Database of Systematic Reviews 2017;5:CD009781

Wipperman JL, Dorsch JN. Evaluation and management of corneal abrasions. Am Fam Physician. 2013;87(2):114-20

Summary

What are Corneal abrasions?

Abrasions of the cornea (the clear window of the eye) are common, being usually caused by a minor accidental injury, for example by a finger, mascara brush or contact lens, or by a speck of foreign matter under the upper eyelid. There are also medical conditions that make abrasions more likely, for example a condition, known as a dystrophy, in which the surface tissue of the cornea (the epithelium) is more delicate than usual; also when the cornea is left exposed by failure of normal blinking, or when its sensitivity to touch is reduced by damage to its nerves, as in diabetes or following shingles of the eye. Corneal abrasion can be very painful as the cornea is one of the most sensitive areas of the body.

How are Corneal abrasions managed?

The optometrist will assess the area involved and prescribe treatment accordingly. Surface damage can be seen more easily if a drop of fluorescein, an orange dye, is put into the eye. Anti-inflammatory or antibiotic eye drops are often recommended, depending on the type and size of abrasion. Dilating eye drops are sometimes given to relieve discomfort.

Corneal abrasions usually heal quickly and completely but if the injury is deeper, or contaminated by foreign material, or possibly infected, referral to an ophthalmologist (eye doctor) is recommended.

Clinical Management Guidelines

Corneal abrasion

Contents

Aetiology

Predisposing factors

Symptoms of corneal abrasion

Signs of corneal abrasion

Differential diagnosis

Management by optometrist

Non pharmacological

Pharmacological

Management category

Possible management by ophthalmologist

Evidence base

Summary

What are Corneal abrasions?

How are Corneal abrasions managed?

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