Corneal abrasion
Definition | Aetiology | Pathophysiology | Risk Factors | Signs and Symptoms | Investigations | Management
Definition
Corneal abrasion is a superficial defect in the corneal epithelium caused by mechanical trauma, leading to pain, photophobia, and foreign body sensation.
Aetiology
- Mechanical trauma: fingernails, contact lenses, makeup brushes.
- Foreign bodies: dust, sand, metal, wood particles.
- Chemical exposure: irritants or cleaning agents.
- Improper contact lens use: prolonged wear, poor hygiene.
- Ocular dryness: predisposes to corneal microtrauma.
Pathophysiology
- Trauma disrupts the corneal epithelium, exposing nerve endings and causing pain.
- Inflammatory response leads to increased tear production and conjunctival hyperaemia.
- Increased risk of secondary bacterial infection if the defect is not properly managed.
Risk Factors
- Contact lens wear.
- Ocular trauma or foreign body exposure.
- Occupational hazards (e.g., construction, metal grinding).
- Dry eye syndrome.
- Previous corneal abrasion or recurrent corneal erosion syndrome.
Signs and Symptoms
- Acute onset eye pain and foreign body sensation.
- Photophobia and excessive tearing.
- Blurred vision (if abrasion is central).
- Conjunctival injection.
- Blepharospasm (involuntary eyelid closure).
Investigations
- Fluorescein staining: reveals epithelial defect under blue light.
- Slit-lamp examination: assesses depth of abrasion and presence of foreign body.
- Eversion of the eyelid: to check for retained foreign bodies.
- Visual acuity testing: assesses impact on vision.
Management
1. Immediate Management:
- Topical lubricants to aid epithelial healing.
- Topical antibiotics (e.g., chloramphenicol ointment) to prevent infection.
- Oral analgesia (paracetamol or ibuprofen) for pain relief.
- Avoid contact lens use until full recovery.
2. Severe Cases:
- Consider cycloplegic drops (e.g., cyclopentolate) if significant photophobia.
- Ophthalmology referral if large defect, signs of infection, or recurrent erosion.
3. Follow-Up:
- Review in 24–48 hours if symptoms persist.
- Educate on eye protection to prevent recurrence.
4. Referral:
- Ophthalmology: if corneal ulcer suspected, persistent symptoms, or recurrent abrasions.
- Occupational health: if work-related injury.