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Corneal abrasion can occur due to an accidental scratch, e.g. with a fingernail or while removing or inserting contact lenses, or by rubbing the eye, e.g. in the presence of a foreign body.Any patient with a penetrating eye injury (or suspected) should be referred immediately for ophthalmological assessment. If ocular penetration is not suspected, examine the eye to locate the foreign body, which may be on the conjunctiva or under the eyelid. N.B. Do not attempt to evert the eyelid if there is a possibility of a penetrating eye injury as the contents of the eye may prolapse.5Fluorescein dye can be used to help to detect the object or an abrasion. Although patients with a penetrating injury should be referred for treatment, if the injury is missed, and the eye is stained, a penetrating injury will be seen as a dark stream (i.e. dye diluted by aqueous) in a pool of bright green (i.e. concentrated dye); this is known as the Siedel sign, although it may be difficult to see without a slit lamp.16To remove a foreign object from the eye, first apply a topical anaesthetic, e.g. tetracaine. Oral pain relief with paracetamol or ibuprofen can also be given.16 Depending on the nature and location of the foreign object, it may be able to be removed by irrigating the eye. If this is not adequate, use a sterile cotton-tipped swab. In some cases, a more precise tool, such as the bevelled edge of a sterile needle may be required.5 This should always be held tangential (on an angle) to the surface of the globe, with the bevel facing the globe, to minimise the chance of corneal perforation. This method can be difficult without the magnification provided by a slit-lamp microscope – if unsure, arrange for the patient to be treated where a slit-lamp is available (Optometrist, hospital emergency department or Ophthalmologist). If the object is embedded and cannot be removed, or if after the object is removed there is a large abrasion, cornealopacity, rust ring (after removing a metal object), a distorted pupil or reduced visual acuity, refer for ophthalmological assessment.5To prevent a secondary infection, in a patient with a corneal abrasion (including after removal of a foreign object) prescribe chloramphenicol 0.5% eye drops, one drop, four times daily, for seven days (or ointment, depending on patient preference). Fusidic acid eye gel 1%, one drop, twice daily, for seven days is an alternative.5An eye patch or dressing is not necessary.12 Contact lenses should be avoided until the abrasion has healed and ideally, until antibiotic treatment has finished. There is usually no need for prescription of anaesthetic drops; prolonged use can lead to corneal damage.15Ideally, the patient should be reassessed in 24 – 48 hours.
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