Corneal abrasion

Visual acuity
If substantially subnormal evaluate for corneal edema versus infectious infiltrate
Pupil shape and reactivity
Irregular or nonreactive pupil suggests pupillary sphincter injury
Evaulate for penetrating injury
Hyphema or hypopyon?
If yes then same same-day ophtho consult is required
Hyphema suggests possible penetrating injury
Extruded ocular contents?
If yes then place eye shield and obtain emergent ophtho referral
Contact lens wearer?
If yes and p/w corneal abrasion AND e/o white spot or opacity on exam concerning for infiltrate or ulceration then refer for same day ophtho appt
Fluorescein Examination
Seidel sign (streaming of fluorescein caused by leaking aqueous humor)
Indicates penetrating trauma (globe microperforation)
Branching pattern suggests possible herpes keratitis
Corneal Ulcer?
Grayish white
Worsening symptoms
> 1day
Intraocular foreign body?
If concern for foreign body but none visualized on external exam consider CT orbit

Foreign Body Removal Techniques

Treatment

Antibiotics - Indicated for all abrasions
Ointment is better than drops due to its lubricant effect
Erythromycin ointment qid x 3-5 days
If treatintg contact lens associated abrasion must cover pseudomonas
E.g. Cipro/ofloxacin or tobramycin drops qid x 3-5 days
Analgesia
Cycloplegics
Consider for patients with large abrasions and photophobia
Cyclopentolate 0.5-1% bid or homatropine 2.5-5% daily for up to 48 hours
Systemic opiods
Never give Rx for topical anesthetics
Tetanus prophylaxis
Only indicated for penetrating injuries, not for abrasions or foreign bodies
Rust Ring
Treat just like pts with corneal abrasions; obtain ophtho f/u in 24-48 hrs for removal of the rust

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