Overview
A corneal abrasion is a scratch or scrape on the cornea, the clear, protective front layer of the eye. This common eye injury occurs when the corneal epithelium (the thin, outer layer of the cornea) is damaged or removed. The cornea is extremely sensitive, containing numerous nerve endings, which makes even small abrasions quite painful.
Corneal abrasions can range from minor superficial scratches to deeper injuries affecting multiple layers of the cornea. While most corneal abrasions are minor and heal quickly within 24-48 hours, larger or deeper abrasions may take several days to heal completely. Proper treatment is essential to prevent complications such as infection or corneal scarring.
The condition is particularly common among contact lens wearers, athletes, and individuals working in dusty or windy environments. Understanding the symptoms and seeking appropriate treatment can prevent complications and ensure proper healing.
Symptoms
Corneal abrasion symptoms typically develop immediately after the injury occurs. The severity of symptoms often correlates with the size and depth of the abrasion.
Primary Symptoms
- Sharp eye pain: Often described as severe, stabbing, or burning pain that may worsen with eye movement or blinking
- Foreign body sensation: Feeling like sand, grit, or something is stuck in the eye, even when nothing is present
- Excessive tearing: The eye produces more tears as a protective response to the injury
- Blurred vision: Vision may be temporarily impaired due to tears, swelling, or the abrasion itself
Secondary Symptoms
- Eye redness: The affected eye becomes red and inflamed due to irritation and increased blood flow
- Light sensitivity (photophobia): Bright lights may cause discomfort or increased pain
- Eyelid swelling: The eyelid may become puffy due to inflammation
- Eye discharge: Clear or slightly cloudy discharge may be present
Symptom Duration
Small, superficial abrasions typically improve within 24-48 hours, while larger or deeper abrasions may cause symptoms for 3-5 days. Persistent symptoms beyond this timeframe may indicate complications or a more serious injury requiring medical evaluation.
Causes
Corneal abrasions can result from various types of trauma or injury to the eye. Understanding common causes can help in prevention and proper treatment.
Mechanical Trauma
- Foreign objects: Sand, dust, dirt, wood chips, or metal particles can scratch the cornea
- Fingernails: Accidental scratching, particularly common in infants and young children
- Tree branches or twigs: Common during outdoor activities or gardening
- Paper cuts: Sharp paper edges can cause superficial corneal scratches
- Makeup applicators: Mascara wands, eyelash curlers, or other cosmetic tools
Contact Lens-Related Causes
- Improper insertion or removal: Rough handling during lens placement or removal
- Torn or damaged lenses: Damaged contact lenses with rough edges
- Overwear: Wearing contacts longer than recommended, causing dryness and friction
- Poor lens hygiene: Dirty or protein-buildup lenses causing irritation
Chemical and Environmental Causes
- Dry eyes: Severe dryness can cause the cornea to become vulnerable to minor trauma
- Chemical exposure: Mild chemical irritants that cause corneal surface damage
- UV exposure: Intense ultraviolet light can cause corneal surface damage
- Wind exposure: Strong, dry winds carrying particles
Medical Conditions
Certain conditions increase the risk of corneal abrasions, including dry eye syndrome, corneal dystrophies, and conditions affecting corneal healing.
Risk Factors
Several factors increase the likelihood of experiencing a corneal abrasion:
Lifestyle and Occupational Factors
- Contact lens wear: Increased risk, especially with improper care or overwear
- Sports participation: Basketball, racquet sports, and contact sports pose higher risk
- Occupational exposure: Construction, farming, metalworking, and other trades with airborne particles
- Outdoor activities: Hiking, camping, gardening, and yard work
Age-Related Factors
- Young children: More likely to accidentally scratch their eyes with fingernails
- Older adults: May have decreased corneal sensation and slower healing
Medical Conditions
- Dry eye syndrome: Insufficient tear production increases vulnerability
- Corneal dystrophies: Genetic conditions affecting corneal structure and healing
- Diabetes: May affect healing and increase infection risk
- Autoimmune conditions: Can affect healing and immune response
Diagnosis
Diagnosis of corneal abrasion typically involves a comprehensive eye examination by a healthcare provider or eye specialist.
Clinical History
The healthcare provider will ask about:
- How the injury occurred and when
- Severity and type of symptoms
- Contact lens use and hygiene practices
- Previous eye injuries or conditions
- Current medications and allergies
Physical Examination
- Visual acuity testing: Checking how well you can see
- External eye examination: Inspecting the eyelids, conjunctiva, and surrounding structures
- Pupil examination: Checking pupil size, shape, and reaction to light
- Eye movement assessment: Evaluating extraocular muscle function
Diagnostic Tests
- Fluorescein staining: A dye is applied to the eye, making abrasions visible under blue light
- Slit-lamp examination: Magnified examination of the cornea and anterior eye structures
- Eyelid eversion: Checking under the eyelids for foreign bodies
- Intraocular pressure measurement: In some cases, to rule out other conditions
Severity Assessment
Abrasions are classified based on size, depth, and location. Central abrasions affecting the visual axis may have greater impact on vision than peripheral injuries.
Treatment Options
Treatment for corneal abrasion focuses on pain relief, promoting healing, and preventing complications. Most abrasions heal naturally with supportive care.
Immediate Care
- Do not rub the eye: This can worsen the injury
- Remove contact lenses: If wearing contacts, remove them immediately
- Flush with clean water: If foreign material is suspected
- Protect the eye: Lightly cover with a clean cloth or eye shield
Medical Treatment
- Antibiotic eye drops: Prevent bacterial infection during healing
- Artificial tears: Keep the eye moist and comfortable
- Cycloplegic drops: Reduce pain by relaxing the ciliary muscle
- Bandage contact lens: For larger abrasions, provides protection and comfort
Pain Management
- Oral pain medication: Acetaminophen or ibuprofen for pain relief
- Cool compress: Can provide comfort but should not be applied directly to the eye
- Avoid topical anesthetics: While these provide immediate relief, they can delay healing
Healing Timeline
- Small abrasions: Usually heal within 24-48 hours
- Medium abrasions: May take 2-3 days to heal
- Large abrasions: Can take 3-5 days or longer
Prevention
Many corneal abrasions can be prevented by following proper safety measures and eye care practices.
Eye Protection
- Safety glasses: Wear appropriate eye protection during work, sports, or outdoor activities
- Sunglasses: Protect from UV rays and wind-blown particles
- Side shields: Additional protection in high-risk environments
- Face shields: For activities with high risk of eye injury
Contact Lens Safety
- Proper hygiene: Always wash hands before handling lenses
- Follow wearing schedule: Don't overwear lenses
- Replace as directed: Use fresh lenses according to schedule
- Proper cleaning: Use appropriate cleaning solutions
- Handle gently: Avoid rough insertion or removal
Environmental Precautions
- Avoid dusty conditions: When possible, stay indoors during dust storms
- Trim fingernails: Keep nails short, especially for children
- Secure loose objects: Prevent items from becoming projectiles
- Use caution with chemicals: Wear protective eyewear when using cleaning products
When to See a Doctor
While many corneal abrasions can be managed at home, certain situations require immediate medical attention.
Emergency Situations
- Severe eye pain that doesn't improve with over-the-counter pain medication
- Significant vision loss or changes
- Large or deep abrasion
- Foreign object embedded in the eye
- Chemical exposure to the eye
- Signs of infection (increasing pain, discharge, fever)
Routine Medical Care
- Any corneal abrasion in contact lens wearers
- Abrasion caused by dirty or contaminated objects
- No improvement after 24-48 hours
- Recurrent corneal abrasions
- Underlying conditions affecting healing
Follow-up Care
Follow-up appointments may be necessary to monitor healing progress and ensure no complications develop. Contact lens wearers typically need clearance before resuming lens wear.
References
- Ahmed, F., House, R. J., & Feldman, B. H. (2015). Corneal abrasions and corneal foreign bodies. Primary Care: Clinics in Office Practice, 42(3), 363-375.
- Wipperman, J. L., & Dorsch, J. N. (2013). Evaluation and management of corneal abrasions. American Family Physician, 87(2), 114-120.
- Turner, A., & Rabiu, M. (2006). Patching for corneal abrasion. Cochrane Database of Systematic Reviews, (2).
- Patel, D. R., & Patel, D. (2017). Management of simple corneal abrasions. Ophthalmology and Therapy, 6(1), 1-8.