Clinical photography: Corneal abrasion

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Image supplied by Jong Lee, Specsavers Belmont Forum, WA

Presentation

This photograph shows an example of a distinct corneal abrasion. The presentation is fairly common, with patients generally complaining of acute trauma (e.g. fingernail scratch, as pictured here), significant pain, photophobia, epiphora and a foreign body sensation in the eye. Other signs and symptoms may include a red eye and blurry vision.

Due to the pain experienced by the patient, a topical anaesthetic will need to be applied to enable the patient to open the affected eye and allow for a proper examination of the cornea. The anaesthetic will also reduce epiphora and excessive reflex tearing of the eye.

The photograph highlights the abrasion as seen by the instillation of fluorescein sodium. Damage to the corneal epithelium causes a distinct depression to this layer at the abrasion site, where the fluorescein will pool. The crescent shape of the stain mirrors the shape of a fingernail.

Management & Prognosis

It is important to rule out other diagnoses such as foreign body injury, infective keratitis and corneal perforation. A foreign body could be an initial cause of a corneal abrasion, however the clinician will need to ensure there is no remnant foreign body in the eye or remove this prior to management. Once a diagnosis has been made, patient prognosis is good. The corneal epithelium is quick to regenerate and heal, and will usually do so within 24 to 48 hours.

Management mainly involves symptom relief and review to ensure quick healing. As any break in the corneal epithelium increases risk of infection, a topical antibiotic such as chloramphenicol or an aminoglycoside is generally prescribed as prophylaxis. Frequent use of non-preserved lubricants (hourly or as often as needed) is recommended to reduce symptoms. In addition to the above, use of a bandage contact lens or over-the-counter oral pain relief medication (e.g. paracetamol, ibuprofen) may also be recommended.

Review of the patient should be within 24 to 48 hours. By this time, the abrasion and subsequent signs and symptoms should almost – if not fully – be resolved.

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