AKT · Ophthalmology/Cornea & ant. segment

Corneal abrasion

Epithelial defect of the cornea (trauma/foreign body/contact lens)

Overview

A traumatic epithelial defect of the cornea (fingernail, branch, foreign body, contact lens). Acutely painful with watering and photophobia; stains green with fluorescein. Heals quickly; the priorities are excluding a penetrating injury/foreign body and avoiding infection (especially in lens wearers).

Recognise

Sudden severe pain, foreign-body sensation, watering, photophobia and blepharospasm after trauma
Fluorescein stains the epithelial defect green under cobalt-blue light
Vision may blur if the abrasion is central; evert the lid to find a retained subtarsal foreign body

Red flags

High-velocity/sharp mechanism, hyphaema/hypopyon, irregular pupil, marked visual loss → penetrating injury — refer immediately, shield the eye, do not pad
Contact-lens-related defect → treat as microbial keratitis risk; do not start steroids
White corneal infiltrate/ulcer → keratitis, not a simple abrasion

Differentials & how to tell them apart

Microbial keratitiswhite stromal infiltrate ± hypopyon, worsening — needs scrape and intensive antibiotics

Recurrent corneal erosionrecurrent pain on waking after a past abrasion

HSV keratitisbranching dendritic pattern on fluorescein, reduced corneal sensation

Penetrating injuryfull-thickness wound, Seidel-positive, distorted pupil — emergency

Investigations

Fluorescein examination; evert the upper lid for foreign bodies. Seidel test if perforation suspected.

Management

Topical antibiotic prophylaxis + analgesia (most heal in 24–48 h)

1Confirm with fluorescein, remove any foreign body (evert the lid), topical antibiotic prophylaxis and analgesia. Most heal within 24–48 hours.Gate: Refer IMMEDIATELY if penetrating injury/intraocular foreign body suspected (high-velocity, sharp, glass) — shield, do not pad or pressurise; refer chemical injury after copious irrigation; treat contact-lens defects as keratitis and do NOT prescribe steroids
2Non-healing/recurrent erosion or any infiltrate → ophthalmology.

Topical antibiotic (chloramphenicol) — prophylaxis while the epithelium heals

Lubricants / analgesia — symptom relief; oral analgesia

Avoid topical anaesthetic for ongoing use — toxic to the epithelium and masks injury

Cycloplegic (e.g. cyclopentolate) — for photophobia/ciliary spasm if severe

Key points

Pain + photophobia + green fluorescein uptake after trauma. The job is to exclude a penetrating injury and to treat lens-wearers as keratitis.

Monitor & prognosis

Review at 24–48 h if not healing.

Excellent for simple abrasions.

Source: NICE CKS Corneal superficial injury