What Is a Corneal Abrasion?

Corneal abrasion is that when some foreign objects, especially rough solids contact the cornea or rub over the corneal surface, they can cause different degrees of corneal abrasions, such as corneal epithelial defect or exfoliation.

Basic Information

English name: corneal abrasion
Visiting department: Ophthalmology
Common locations: cornea

Common causes: Shock waves from masonry, fists, balls, falls, traffic accidents, and explosions
Common symptoms: Pain, tearing, eyelid spasm, etc.
Contagious: no

Causes of corneal abrasions

The most common causes of corneal abrasions are masonry, fists, balls, falls, traffic accidents, and shock waves from explosions.

Corneal abrasion clinical manifestations

Due to the exposed sensory nerve endings, the patient suddenly developed obvious pain, tears, eyelid spasm and other irritation symptoms, and the pain worsened when blinking or eyeballs were turned. Even if no foreign body remains, the patient still has a significant foreign body sensation.

Corneal abrasion test

Oblique method

Corneal epithelial defects can be found by oblique illumination with focus light (such as a flashlight light source, etc.). At the same time, you should look for foreign bodies in the cornea or conjunctiva.

2. fluorescein staining method

If epithelial defects are not found by oblique illumination, fluorescein staining can be used. The method is to drop a drop of 20% sodium fluorescein sterile solution into the conjunctival sac, and instruct the patient to close his eyes for 5 minutes, and then stop for a while, then the patient's tears can flush the remaining dye in the conjunctival sac (if there is still more The dye can be removed by rinsing with physiological saline). At this time, the corneal epithelial defect is stained with green and easy to find.

3.fluorescein paper staining

That is, use a strip of sterilized fluorescein paper and drop a drop of sterile saline to make one end contact the conjunctiva.

4. Projection

Check for small, non-obvious abrasions. Projecting the cornea with a good focus light source shows that a projection of the epithelial defect area appears on the surface of the iris. If the projection angle is changed, the projection has a corresponding reverse movement.

5. Fracture-type microscopy

If the patient is contacted for examination in a hospital with ophthalmic equipment, of course, the examination of a slit-type microscope is more convenient.

Corneal abrasion diagnosis

Corneal Abrasion Treatment

Simple shallow abrasion

The treatment effect is good. If only the corneal epithelium is damaged or the epithelial layer is stripped from the anterior elastic layer, most of them can be repaired within 12 hours, and the larger range takes longer. However, if improper treatment or infection occurs, it will not only prolong the course of the disease, but also leave corneal opacity to varying degrees. The treatment method is:

(1) Clean the conjunctival sac. If the conjunctival sac contains foreign matter, debris, dust, dirt, etc., use sterile physiological saline or antibiotic eye drops to rinse it off during the first treatment.

(2) antibiotic drops eye drops antibiotic drops, several times a day.

(3) Apply broad-spectrum antibiotic eye ointment tobramycin eye or ofloxacin eye ointment.

(4) Weak mydriatic agents, such as larger abrasions and severe irritation symptoms, can be applied with weak mydriatic agents, such as 2% post-barthine or tropinamide, to reduce symptoms and reduce secondary iris and eyelashes. The impact of stipitomy.

(5) Bandaging the wounded eyes After applying eye ointment, cover with sterile gauze and apply pressure goggles or pressure bandages. In order to make it a slight pressure, the eyelid is pressed so that it cannot move with the eyelid opening and closing of the other eye, and does not apply great pressure to the eyeball. This can reduce the friction of the eyelid on the cornea, and is beneficial to the repair of the corneal epithelium. The pressure bandaging should be continued for 24 hours after the symptoms disappear. Generally only the wounded eye can be bandaged, but if the abrasion area is large or unhealed, the eyes can also be bandaged.

(6) Control the infection. If the pain worsens, or begins to be mild, and then suddenly worsens, it should be checked immediately. If an infection is found, it should be actively controlled.

(7) Anti-infection and lamellar corneal transplantation . The treatment of repetitive corneal erosions is mainly to apply antibiotics topically to prevent infection. Bandaging is sometimes effective. To prevent recurrence, apply eye ointment to the conjunctival sac before bedtime for several weeks. Wearing soft contact lenses sometimes works well. Vitamin C can also be taken orally. If an infection has occurred, it can be treated as ulcerative keratitis. If repeated attacks are not effective, lamellar corneal transplantation can be used.

Corneal laceration

In addition to cleaning the wound to remove dirt and topical application of antibiotics to prevent infection, pressure bandaging and pain relief should be used to reduce the patient's pain, such as those with large and deep lacerations and obvious open wounds or poor alignment. A full suture of the cornea is not perforated and proper suture surgery should be considered. When stitching, be sure to use fine needles and thin threads. It is best to use non-destructive suture needles with 10-0 monofilament nylon sutures. The wound edges should be carefully aligned. Too tight.

3. corneal foreign body

(1) Foreign objects on the surface of the cornea can be removed by rinsing, that is, the water flow during eyewash or irrigator flushing to the bulbar conjunctiva close to the foreign objects can be washed away. In this method, the cornea Minimal damage.

(2) Although the foreign body is wiped off on the corneal surface, but it cannot be removed by rinsing, you can drop a surface anesthetic, such as a 1% caine solution, with a wet cotton swab dipped in physiological saline, and lighten the foreign body. Gently wipe away. The foreign body embedded in the superficial layer of the cornea, if the end is exposed on the corneal surface, you can also try to wipe it off with a wet cotton swab as described above.

(3) If the needle removes the foreign body, if it does not expose the corneal surface, or if it is exposed but incarcerated firmly, it cannot be removed by the above method. Under foreign anesthesia, it can be removed with a foreign body needle or a fine injection needle. Toward the top of the head, in case the patient avoids or suddenly closes the eyelids and turns the needle tip too deeply.

(4) Superficial corneal incision to remove foreign objects located in the deep layer. If it is magnetic, you can cut the superficial cornea to reach the foreign object and then suck it out with an electromagnet or permanent magnet; if it is non-magnetic or cannot be sucked out with a magnet For magnetic foreign bodies, you must first cut a small corneal flap to separate the layers, lift up the flap to expose the foreign body, and carefully remove it. Because the corneal flap is small and can not be sutured, after the corneal flap is reset, the affected eye is bandaged. Bandaging for 24 to 48 hours. The corneal flap can also be closed without damage to the corneal needle and 10-0 sutures. Deep corneal foreign bodies must be handled with extreme care, otherwise they may be pushed deeper into the cornea when they are removed, causing them to penetrate the cornea and fall into the anterior chamber; or due to the outflow of aqueous humor, the anterior chamber may become shallower or disappear, and foreign objects or instruments may damage the iris or Crystal.

(5) Corneal incision to remove foreign bodies, such as those who have entered the anterior chamber with one end, should shrink the pupil and then cut the cornea from the limbus, insert the anterior chamber with an iris restorer, hold the foreign body behind the cornea, and then remove it from the cornea. Or, cut a corneal flap as described above, and remove the foreign body from under the flap. You can also deliberately drop a foreign body into the anterior chamber to the surface of the iris after shrinking the pupil, and then remove it by pressing the foreign body in the anterior chamber.

(6) If lamellar keratoplasty or epithelial scraping is a large number of debris or dust-like foreign matter for several days, the larger particles exposed on the surface can be removed. Later, as the foreign body gradually moves forward to the surface, it will be exposed and removed one after another. If there are many debris and severe irritation, lamellar corneal transplantation or epithelial curettage can be used to remove the superficial foreign body.

(7) After removing the foreign body in the post-treatment , apply antibiotic eye ointment and cover the eyes with sterile gauze. Change dressings daily until healed. Generally, after the foreign body is removed, the wound is very small, and the corneal epithelium can be repaired within 24 hours. Larger and deeper wounds will take longer. If an infection has occurred, treat it as a corneal ulcer.