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Corneal superficial injury - Management
How do I assess a superficial corneal injury?
- Determine how the injury was caused, in particular if it was due to chemicals or a high-velocity foreign body. It is important not to miss a penetrating eye injury.
- Ask specifically about activities that may have caused a high-velocity injury (e.g. chiselling, grinding, hammering, or lawn mowing), as a foreign body may enter the eye without the person realizing.
- Ask about specific causes of a corneal injury, such as trauma from grit, wood chip, fingernails, hairbrush, or contact-lens problems (e.g. poor fit, trapped foreign body, sensitivity to solutions, infection).
- Assess for the degree of injury:
- Test visual acuity in both eyes with a Snellen chart, and document carefully.
- Test the extra-ocular eye muscles by assessing eye movements in all directions and eyelid function.
- Examine both pupils for size shape and reaction to light.
- Look for the presence of a subconjunctival haemorrhage.
- Look for the presence of a hyphaema (blood in the anterior chamber).
- Use fluorescein stain to assess the size, shape, and position of the corneal abrasion, and document carefully.
- Use a slit lamp (if available) to reveal corneal oedema, epithelial disruption, or anterior chamber penetration.
- Evert the upper lid to exclude a subtarsal foreign body, unless a penetrating eye injury is suspected.
- Consider using a topical anaesthetic (e.g. proxymetacaine, or tetracaine) if examination is difficult. Topical anaesthetics are also available combined with fluorescein.
Clarification / Additional information
- Documentation of visual acuity and the size of the abrasion is essential for follow up and medico-legal purposes.
Basis for recommendation
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