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Corneal abrasion (ReelDx)

REEL-DX-ENHANCED-REGISTERED Corneal Abrasian

8 y/o with eye pain and redness

Patient will present as → a 10-year-old boy who was hit in the right eye with a piece of bark that was thrown on the playground. He developed sudden onset of eye pain, photophobia, tearing, and blurring of vision. He claims there is "something stuck in my eye." On physical examination, there is significant conjunctival injection.

A corneal abrasion is a superficial scratch on the clear, protective "window" at the front of your eye (cornea)

  • Corneal abrasions are the most common ophthalmologic visit to the emergency department and are a commonly seen problem in urgent care
  • Corneal abrasions most commonly result from accidental trauma (e.g., fingernail scratch, makeup brush): dirt, sand, sawdust, or other foreign body gets caught under the eyelid

Diagnose with fluorescein staining - increased absorption in the devoid area

  • Must be able to differentiate corneal abrasion from a corneal ulcer – They will appear different on an exam, ulcers are often visible without fluorescein, and abrasions will be seen on fluorescein often as a thin line
Human cornea with abrasion highlighted by fluorescein staining

A cornea with abrasion highlighted by fluorescein staining

Topical anesthetic - immediate relief (do not dispense). Treat with topical antibiotic ointment (preferable to drops) as lubrication will likely help.

  • Ophthalmic antibiotics
    • For patients who are NOT contact lens wearers, erythromycin ointment (Ilotycin, Diomycin, Erocin) is a good choice, used four times daily for three to five days.
    • Contact lens wearers with corneal abrasions require an antibiotic with optimal antipseudomonal coverage (eg, ciprofloxacin, ofloxacin, or if fluoroquinolones are not available, tobramycin or gentamicin).
  • Patching for corneal abrasions is generally no longer recommended because it may delay corneal healing
  • Follow up daily. Refer if large or central

Question 1
A 28-year-old construction worker presents with acute onset of severe eye pain, tearing, and photophobia after a day of work. He reports that some debris flew into his eye while he was grinding metal. Which of the following is the most likely diagnosis?
A
Acute angle-closure glaucoma
Hint:
Presents with severe eye pain but is associated with blurred vision and halos around lights, not typically related to trauma.
B
Chemical burn
Hint:
Would involve a history of exposure to a chemical substance.
C
Infectious keratitis
Hint:
Usually develops over a longer period and not immediately after trauma.
D
Corneal abrasion
E
Uveitis
Hint:
Inflammation inside the eye, not typically caused by superficial trauma.
Question 1 Explanation: 
Corneal abrasion is a common ocular injury, especially in settings involving exposure to foreign bodies, such as in construction work. It presents with symptoms like severe eye pain, tearing, and photophobia, typically following a history of trauma or foreign body contact with the eye.
Question 2
A 22-year-old woman presents to the emergency department complaining of right eye pain after accidentally poking her eye with her fingernail. On examination, her right eye is red and tearing. What is the most appropriate diagnostic test to confirm the diagnosis?
A
Slit-lamp examination with fluorescein staining
B
Intraocular pressure measurement
Hint:
Important in glaucoma but not primarily for diagnosing corneal abrasion.
C
Fundoscopic examination
Hint:
Used to examine the internal structures of the eye, not the cornea.
D
CT scan of the orbit
Hint:
Indicated in cases of suspected orbital fractures or deep foreign bodies.
E
Schirmer's test
Hint:
Measures tear production, not relevant for diagnosing corneal abrasions.
Question 2 Explanation: 
Slit-lamp examination with fluorescein staining is the most appropriate diagnostic test for corneal abrasion. Fluorescein dye highlights defects in the corneal epithelium, making abrasions visible under a blue light during slit-lamp examination.
Question 3
A 35-year-old male is diagnosed with a small corneal abrasion after getting sawdust in his eye while woodworking. He has no history of contact lens use and no evidence of a retained foreign body. What is the most appropriate treatment for his condition?
A
Patching the affected eye
Hint:
No longer routinely recommended for small corneal abrasions.
B
Systemic antibiotics
Hint:
Not necessary for uncomplicated corneal abrasions.
C
Steroid eye drops
Hint:
Not indicated in the initial treatment of corneal abrasions and can delay healing.
D
Immediate surgical intervention
Hint:
Reserved for severe ocular injuries, not small corneal abrasions.
E
Topical antibiotic ointment and pain management
Question 3 Explanation: 
The most appropriate treatment for a small corneal abrasion is topical antibiotic ointment to prevent infection and pain management. This approach is especially indicated in cases without contact lens use or retained foreign bodies.
Question 4
A 57-year-old male farmer presents to the clinic a few days after an incident where manure hit his left eye. He complains of a red, painful eye with tearing. Fluorescein staining reveals a corneal abrasion that resembles a shallow crater. Which of the following interventions would be potentially harmful in this case?
A
Prescribing ophthalmic antibiotics
Hint:
These are typically indicated in the treatment of corneal abrasions to prevent bacterial infections, especially when the abrasion is due to organic material.
B
Applying a pressure patch to the affected eye
C
Conducting an examination for visual acuity
Hint:
Assessing visual acuity is an important part of the ocular examination and is not harmful.
D
Performing copious irrigation of the eye
Hint:
This is an appropriate initial step, especially if there is a concern for contamination with foreign material, to help remove any remaining particles.
E
Prescribing topical nonsteroidal anti-inflammatory drugs (NSAIDs)
Hint:
While these can be used for pain management, they are not inherently harmful in the treatment of corneal abrasions, unless contraindicated.
Question 4 Explanation: 
Applying a pressure patch in the case of a corneal abrasion, especially when the injury involves organic material like manure, can be harmful. It creates a warm, moist environment that can promote bacterial growth and increase the risk of infection. The current standard of care for corneal abrasions typically involves avoiding pressure patches, particularly in cases with a high risk of infection.
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References: Merck Manual · UpToDate

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