5.3 Abrasion, Corneal

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

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