Managing Corneal Abrasions in the ED: Blink and It Hurts

-Case-
A 27-year-old woman comes to the ED with severe left eye pain after accidentally scratching it while removing her contact lenses. She describes a foreign body sensation, photophobia, and excessive tearing. Her vision is slightly blurry but mostly intact. On exam, you note mild conjunctival injection and she’s holding her eye closed due to discomfort. Fluorescein staining under Wood’s lamp reveals a linear uptake on the cornea.

-Evaluation-
Corneal abrasions are among the most common ocular complaints in the ED. They often result from trauma (e.g., fingernails, makeup tools, contact lenses, foreign bodies) and are characterized by disruption of the corneal epithelium.

  • Symptoms:
    • Eye pain, tearing, photophobia
    • Foreign body sensation
    • Blurred vision (often mild)
    • Blepharospasm (involuntary tight closure of eyelids)
  • History Clues:
    • Recent trauma or contact lens use
    • Occupational or recreational exposures (e.g., welding)
  • Physical Exam:
    • Visual acuity
    • Fluorescein staining (linear uptake, will be dendritic if HSV!)
    • Slit lamp if available
    • Evert eyelid to check for retained foreign bodies

-Management-

  1. Topical Antibiotics:
    • Erythromycin ointment or polymyxin/trimethoprim drops for non-contact lens users
    • Fluoroquinolone drops (e.g., ciprofloxacin, ofloxacin) for contact lens wearers (crucial for pseudomonas coverage!)
  2. Pain Control:
    • Oral NSAIDs (e.g., ibuprofen)
    • Consider cycloplegic drops (e.g., cyclopentolate) for severe photophobia
  3. Avoid:
    • Topical anesthetics for home use (delay healing, risk of corneal damage)
    • Eye patching (generally not recommended)
  4. Follow-Up:
    • Ophthalmology referral if symptoms persist >48 hours, contact lens-associated abrasions, or concerns for complications

-Fast Facts-

  • Always check visual acuity first; ophthalmology will love you for it!
  • Fluorescein staining is diagnostic
  • Contact lens wearers need pseudomonas coverage
  • Most abrasions heal within 24-72 hours

Intense discomfort, photophobia, and a clear trigger are classic for corneal abrasion. With the right diagnosis and early management, these injuries typically heal quickly and without any complications. Just remember to cover the right bugs, avoid patching, and send patients home with both pain relief and reassurance. The eye may water, but your management should be crystal clear!

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Cheers,

Tamir Zitelny, MD

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References:

  1. Wilson SA, Last A. Management of corneal abrasions. Am Fam Physician. 2004;70(1):123-128.
  2. Wipperman JL, Dorsch JN. Evaluation and management of corneal abrasions. Am Fam Physician. 2013;87(2):114-120.
  3. Verma S, Corneal abrasion. In: StatPearls. Treasure Island, FL: StatPearls Publishing; 2024. https://www.ncbi.nlm.nih.gov/books/NBK459283/
  4. Abdullah HA, Cornelius N. Diagnosis and Management of Eye Pain in Primary Care. Prim Care. 2015;42(3):377-390. doi:10.1016/j.pop.2015.05.002
  5. McGwin G Jr, Hall TA, Seale JL, et al. Incidence and characteristics of eye injuries in a population-based study. JAMA Ophthalmol. 2005;123(3):279-283. doi:10.1001/archopht.123.3.279

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