Corneal abrasions

Overview 
Theory 
Diagnosis 
Management 
Follow up 
Resources 

Last reviewed: 21 Nov 2024

Last updated: 10 Oct 2024

10 Oct 2024

Limit topical anesthetics to single use for initial symptom relief and to aid exam

Repeated use of topical anesthetics may be toxic to the corneal epithelium and may impair healing (e.g., risks corneal melting, ring infiltrates, and infection).[13][15][16]

Topical anesthetics can provide initial symptom relief and aid exam in patients with corneal abrasions or recurrent corneal erosions, but should be limited to single use by a medical professional.[13][15][16]

Patients should not receive topical anesthetics for use at home.[15]

See Management: approach

Original source of update

Corneal abrasions usually have a sudden onset. Typical symptoms include a foreign body sensation (even if none present), photophobia, excessive tearing, blepharospasm, and blurry vision.

Treatment involves adequate analgesia and topical antibiotics. Contact lens wearers are at increased risk of Pseudomonas infection.

Patching does not speed up healing or offer pain relief.

Most abrasions heal within 1 or 2 days and have very few sequelae.

Larger defects, or those associated with contact lens use, should have ophthalmologic follow-up in 1-2 days to ensure healing.

Complications are rare but include corneal ulceration and keratitis.

Definition

Corneal abrasions are corneal epithelial defects. They are common and are typically caused by mechanical trauma from external objects such as fingernails and branches, foreign bodies that become lodged underneath the eyelids, or contact lens use. Patients who have had a previous injury and structural defects to the corneal epithelium are at risk for spontaneous abrasions known as recurrent erosions.

History and exam

Key diagnostic factors

eye pain
tearing
photophobia
blurred vision
ciliary flush

Full details

Other diagnostic factors

presence of foreign body
red reflex
corneal opacity
rust ring
blepharospasm

Full details

Risk factors

eye trauma
foreign body in the eye
contact lens use
working in the automobile industry
lack of protective eyewear
prior corneal abrasion
deployment of airbag during automobile collision

Full details

Diagnostic tests

1st tests to order

visual acuity
fluorescein staining

Full details

Tests to consider

CT scan of head and orbits

Full details

Treatment algorithm

ACUTE

acute corneal abrasion

ONGOING

recurrent corneal erosions or poor healing

Contributors

Authors

Christopher McStay, MD

Associate Professor of Emergency Medicine

Department of Emergency Medicine

Columbia University College of Physicians and Surgeons

New York

Disclosures

CM declares that he has no competing interests.

Peer reviewers

Christopher Tedeschi, MD

Instructor in Clinical Medicine

Emergency Medicine Department

New York Presbyterian Hospital

Columbia University Medical Center

New York

Disclosures

CT declares that he has no competing interests.

Rasik Vajpayee, MD

Chair of Ophthalmology

Corneal and Cataract Surgery

University of Melbourne

Melbourne

Australia

Disclosures

RV declares that he has no competing interests.

Differentials
- Conjunctivitis
- Corneal laceration with globe perforation
- Corneal ulceration and ulcerative keratitis
More Differentials
Guidelines
- Cornea/external disease summary benchmarks - 2023
- Cornea/external disease summary benchmarks - 2023
More Guidelines
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Corneal abrasions

Limit topical anesthetics to single use for initial symptom relief and to aid exam

Summary

Definition

History and exam

Key diagnostic factors

Other diagnostic factors

Risk factors

Diagnostic tests

1st tests to order

Tests to consider

Treatment algorithm

acute corneal abrasion

recurrent corneal erosions or poor healing

Contributors

Authors

Christopher McStay, MD

Disclosures

Peer reviewers

Christopher Tedeschi, MD

Disclosures

Rasik Vajpayee, MD

Disclosures

Differentials

Guidelines

Log in or subscribe to access all of BMJ Best Practice

Log in or subscribe to access all of BMJ Best Practice

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