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Clin Ophthalmol. 2010; 4: 387–390.
Published online 2010 May 6.
PMCID: PMC2866569

Corneal abrasion

Abstract

Clinical question:

What is the best treatment for traumatic corneal abrasion?

Results:

Eye patching does not reduce pain in patients with corneal abrasions. Topical diclofenac does reduce pain in patients with corneal abrasions

Implementation:

Pitfalls to avoid when treating abrasions:

  • Treatment of small abrasions
  • Treatment of larger abrasions
  • When to refer for specialist treatment
Keywords: corneal abrasion, corneal epithelial surface, traumatic corneal abrasion

Corneal abrasion

Definition:

A corneal abrasion is a defect in the corneal epithelial surface. Etiology: Usually traumatic – but can occur spontaneously, eg, dry eyes, neurotrophic eyes.

Incidence:

One study suggests that over 10% of new presentations at eye accident departments are for traumatic corneal abrasion.1

Economics:

No published study has addressed the economic issues of corneal abrasion. These would include the frequency of presentation to eye departments, time off work and cost of medications to the (usually younger) individuals.

Level of evidence used in this summary:

Systematic reviews, meta-analyses, RCTs.

Search sources:

PubMed, Cochrane Library, NHS evidence, DARE, clinical evidence.

Outcomes:

From the patient perspective the main outcomes:

  1. Speed of healing of the abrasion.
  2. Pain relief during healing.
  3. Avoidance of complications.

Consumer summary:

A corneal abrasion is a scratch of the surface of the eye. It is usually caused accidentally, eg, a fingernail, contact lens. It is very painful immediately and medical attention should be sought. There is good evidence that a combination of drops is the quickest and most comfortable way to make the abrasion heal.

Further reading:

  • Wormald R, Smeeth L, Henshaw K. Evidence Based Ophthalmology. London: BMJ Books; 2004.
  • Ehler Justis P, Shah Chirag P, Fenton Gregory L. The Wills Eye Manual: Office and Emergency Room Diagnosis and Treatment of Eye Disease. Baltimore: Lippincott, Williams and Wilkins; 2008.
  • Denniston AKO, Murray P. Oxford Handbook of Ophthalmology. Oxford: Oxford University Press; 2006.

References

1. Acheson JF, Joseph J, Spalton DJ. Use of soft contact lenses in an eye casualty department for the primary treatment of traumatic corneal abrasions. Br J Ophthalmol. 1987;71:285–289. [PMC free article] [PubMed]
2. Turner A, Rabiu M. Patching for corneal abrasion. Cochrane Database Syst Rev. 2006;(2):CD004764. [PubMed]
3. Flynn CA, D’Amico F, Smith G. Should we patch corneal abrasions? A meta-analysis. J Fam Pract. 1998;47(4):264–270. [PubMed]
4. Kaiser PK. A comparison of pressure patching versus no patching for corneal abrasions due to trauma or foreign body removal. Corneal Abrasion Patching Study Group. Ophthalmology. 1995;102(12):1936–1942. [PubMed]
5. Kirkpatrick JN, Hoh HB, Cook SD. No eye pad for corneal abrasion Eye 1993. 7(Pt 3)468–471.471 [PubMed]
6. Campanile TM, St Clair DA, Benaim M. The evaluation of eye patching in the treatment of traumatic corneal epithelial defects. J Emerg Med. 1997;15(6):769–774. [PubMed]
7. Arbour JD, Brunette I, Boisjoly HM, Shi ZH, Dumas J, Guertin MC. Should we patch corneal erosions? Arch Ophthalmol. 1997;115(3):313–317. [PubMed]
8. Le Sage N, Verreault R, Rochette L. Efficacy of eye patching for traumatic corneal abrasions: a controlled clinical trial. Ann Emerg Med. 2001;38(2):129–134. [PubMed]
9. Patterson J, Fetzer D, Krall J, Wright E, Heller M. Eye patch treatment for the pain of corneal abrasion. South Med J. 1996;89(2):227–229. [PubMed]
10. Jayamanne DG, Fitt AW, Dayan M, Andrews RM, Mitchell KW, Griffiths PG. The effectiveness of topical Diclofenac in relieving discomfort following traumatic corneal abrasions Eye 1997. 11(Pt 1)79–83.83 [PubMed]
11. Szucs PA, Nashed AH, Allegra JR, Eskin B. Safety and efficacy of Diclofenac ophthalmic solution in the treatment of corneal abrasions. Ann Emerg Med. 2000;35(2):131–137. [PubMed]
Clin Ophthalmol. 2010; 4: 388.
Published online 2010 May 6.

The evidence

Do any interventions make a difference to the rate of healing?

Systematic reviews:1
Meta-analysis:1
Randomized controlled trials:5

The Systematic Review2 concluded that ‘Treating simple corneal abrasions with a patch does not improve healing rates on the first day post-injury. In addition, use of patches results in a loss of binocular vision’.

The meta-analysis3 stated ‘Eye patching was not found to improve healing rates in patients with corneal abrasions’

Randomized trials – see table below. The studies generally found that padding the eye either made no difference to the rate of healing or that topical antibiotic and cycloplegia led to faster healing of the abrasion.

Conclusions

Use a topical antibiotic and cycloplegic for traumatic corneal abrasions.

Which treatments are best for reducing the pain of a corneal abrasion?

Systematic reviews:1
Meta-analysis:1
Randomized controlled trials:7

The Systematic Review2 concluded ‘Treating simple corneal abrasions with a patch does not reduce pain’.

The meta-analysis3 concluded ‘Eye patching was not found to reduce pain in patients with corneal abrasions’. As far as the drop regime is concerned the interventions were variable so no specific regime was recommended.

RCTs – see Table 2. The studies generally found that padding the eye either made no difference to reported pain or in one study was more painful. Two studies indicate that topic diclofenac relieves abrasion pain more than placebo.

Table 2
RCTs comparing interventions with reported pain

Conclusions

Eye patching does not reduce pain in patients with corneal abrasions.

Topical diclofenac does reduce pain in patients with corneal abrasions.

Recurrent corneal abrasion

See separate topic.

Table 1
RCTs comparing interventions with rate of healing
Clin Ophthalmol. 2010; 4: 389.
Published online 2010 May 6.

The practice

Potential pitfalls

  • Take care with contact lens wearers – they should be carefully monitored (review daily) with a slit lamp to look for signs of secondary infection. Normal CL wear should be avoided until healing has occurred and drops have been stopped.

Management

Corneal abrasion can be managed by non-specialists. Indications for specialist referral are given below.

Assessment

  • There should be a history of direct trauma e.g. poked with a finger.
  • If history suggests a more severe/high impact injury, eg, direct trauma with a sharp object, hammer and chisel fragment refer to an eye specialist.
  • Ask about contact lens wear.
  • Abrasions are easily seen with Fluorescein drops and a blue light.
  • If the abrasion is apparently spontaneous abrasion think of recurrent abrasion syndrome (see topic).

Treatment

Small abrasions with moderate pain

  • Chloramphenicol ointment qds until the eye feels comfortable.
  • Review only if the eye becomes more painful.

Large (> 4 mm) and/or painful abrasions

  • Chloramphenicol ointment qds, g. diclofenac drops 0.1% qds and g. cyclopentolate 1% tds to the affected eye.
  • The patient should be warned their vision will be blurred secondary to the cyclopenetolate and they should not drive.
  • Review in 24 hours and if improving there is no need to review unless symptoms worsen again.

Bandage contact lenses should only be used in specialist departments and in those with experience of their use.

Indications for specialist referral

  • A history of significant trauma
  • Worsening of symptoms despite treatment
  • Infiltrate around edge of abrasion (may suggest infection)
  • Recurrent erosion syndrome

Articles from Clinical Ophthalmology (Auckland, N.Z.) are provided here courtesy of Dove Press