Corneal abrasion
- Etiology & Risk Factors:
- Mechanical trauma (fingernail, branches, foreign body [FB]).
- Contact lens (CL) wearers (predisposes to Pseudomonas aeruginosa).
- Clinical Presentation:
- Severe eye pain, foreign body sensation, photophobia, tearing, blepharospasm.
- Diagnosis:
- Visual acuity (VA): Must be assessed first before eye manipulation.
- Fluorescein stain + cobalt blue light: Confirmatory (bright green epithelial defect).
- Slit-lamp + eyelid eversion: Rule out retained subtarsal FB or stromal infiltrate.
- Seidel test: Negative (if positive/streaming dye = open globe perforation).
- Key Differentials:
- Corneal ulcer (keratitis): Visible white stromal infiltrate ± hypopyon.
- Herpes simplex keratitis: Dendritic (branching) ulcer.
- Open globe: Peaked/teardrop pupil, flat anterior chamber, (+) Seidel test.
- Management:
- Non-CL wearers: Topical Abx (e.g., Erythromycin ointment, Polymyxin B/Trimethoprim drops).
- CL wearers: Topical anti-pseudomonal fluoroquinolone (e.g., Ciprofloxacin, Ofloxacin); stop CL use immediately.
- Analgesia: Oral NSAIDs; topical cycloplegics (e.g., cyclopentolate) for ciliary spasm/photophobia.
- Tetanus prophylaxis: Update if dirty FB or trauma.
- Contraindications (High-Yield):
- NEVER patch the eye (promotes bacterial infection).
- NEVER prescribe topical anesthetics for outpatient use (causes corneal toxicity/melting).
- Avoid topical steroids (delays healing, exacerbates infections).
- Ophthalmology referral: If symptoms persist/worsen after 24–48h, large central lesion, or corneal infiltrate develops.
- Complications:
- Bacterial keratitis / corneal ulceration.
- Recurrent corneal erosion syndrome.
- Corneal scarring with permanent visual loss.