Date of last review: Due to be updated

Differential diagnosis

  • Infectious keratitis
  • Recurrent corneal erosion
  • Corneal Dystrophy
  • Photokeratitis (welder’s flash, snow blindness)

Possible management by Optometrist

  • Examine cornea, upper and lower eyelids and eye
    • If examination is difficult due to patient discomfort or photophobia, use 1 drop of local anaesthetic drops
  • Explain diagnosis
  • Reassure the patient
  • Determine how the injury was caused
  • In particular rule out chemical injury and penetrating trauma

Evaluate abrasion using fluorescein

  • Size (use length of slit beam) and location
  • Depth
  • Edge quality
  • Oedema beneath abrasion
  • Confirm no corneal foreign body present

Evaluate anterior chamber reaction

Evert eyelids to confirm no foreign body present

Treatment

  • Topical anaesthetic (e.g. benoxinate 0.4%) if necessary to aid examination
  • Ocular lubricants for symptomatic relief (drops for use during the day, unmedicated ointment for use at bedtime)
  • If there is a possibility of infection, prescribe a broad spectrum topical antibiotic
    • Ask if allergic to Chloramphenicol
    • If not, supply Chloramphenicol 1% eye ointment 3 times daily for 5 days
    • If allergic to Chloramphenicol, or pregnant, supply Fusidic acid 1% liquid gel twice a day for 5 days
  • Consider cycloplegia to prevent pupil spasm
    • Cyclopentolate 1% 3 times daily until healed
  • Consider therapeutic contact lens fitting
  • Refer to local Pharmacist for analgesia for pain relief (Paracetamol or Ibuprofen; dose depends on age)
  • PoM Also consider a topical NSAID for its analgesic and anti-inflammatory properties, e.g. diclofenac 0.1% up to four times daily for 1-3 days

Advice

  • Do not patch eye
  • Discharge patient, with offer to review if symptoms do not start to improve within 1-2 days
  • Contact lens wearers should temporarily cease usage.
    • Ask contact lens wearer to return in one week to ensure epithelium intact on slit lamp
    • If intact at one week, recommend a further week without contact lenses
  • Advise on suitable eye protection

Management Category

  • Management to resolution
  • if abrasion deep and/or contaminated with foreign material, or apparently infected, refer as emergency (same day) to Ophthalmologist

Possible management by Ophthalmologist

  • Assess for secondary infection
  • Debridement if indicated
  • Therapeutic contact lens fitting