35-year-old woman landscaper presents with left eye pain, tearing, blurry vision, and the sensation of something in her eye.

The image is consistent with a diagnosis of Corneal Abrasion.

• What is it? Superficial scratch, scrape, or cut on surface of the cornea → Disruption of the epithelium layer
• Causes? Anything that can scratch the surface of the eye: fingernails, makeup brushes, tree branches, sand, etc. 
• Symptoms? Eye pain, decreased visual acuity, sensation of a foreign body, tearing, redness 

• Administer a proparacaine eye drop to give the patient instant relief in order to ease pain during examination (note: the drop is not given for treatment of pain).
• Perform an eye examination including visual acuity, penlight examination, assessment of extraocular muscles, fundoscopic examination, and eyelid eversion to check for a retained foreign body.
• Administer a fluorescein stain and note that cobalt blue light reveals corneal abnormalities (see image).

• Indications for ophthalmologist consultation include: 
  • Signs of an open globe injury
  • Signs of hyphema
  • Signs of ulceration
  • A foreign body that cannot be removed
  • Hypopyon
  • Purulent discharge
  • Drop in visual acuity (VA) by more than 1-2 lines on a Snellen chart
  • Poor healing after 3-4 days

• Antibiotic eye drops or ointment
• Moisturizing eye drops or ointment
• Steroids are contraindicated because they slow epithelial healing
• Instruct patients to avoid contact lenses until full recovery
• Prevention: 
  • Wear safety goggles when mowing a lawn, trimming brushes, cutting wood, etc.
  • Clip children’s fingernails (children can accidentally scratch their corneas with their fingernails)
  • Use caution when applying eye makeup, particularly with brushes and flash eyelashes 
  • Counsel regarding prevention in the future

• Corneal Abrasion and Erosion
• Layers of the Cornea (Interactive Figure)
• Trauma of the Anterior Segment (Video)
• Corneal Causes of Red Eye (Video)
• Painful Red Eye (Interactive Case)