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Corneal superficial injury - Management
Overview of management

  • Assess:
    • Whether the injury was due to chemicals or a high-velocity foreign body.
    • The degree of injury. Test visual acuity and extra-ocular eye muscles, and examine both pupils for size, shape and reaction to light.
    • The size, shape, and position of the corneal abrasion using fluorescein stain, and document carefully.
    • Corneal oedema, epithelial disruption, or anterior chamber penetration, using a slit lamp (if available) to reveal any problems.
  • Refer urgently to the emergency eye service:
    • All high-velocity injuries and chemical injuries.
    • If there is a foreign body that cannot be removed.
    • If any of the following clinical features are present:
      • Pain which is not relieved by topical local anaesthetic.
      • A reduction in visual acuity.
      • Large abrasions, corneal opacities, or rust rings.
      • Hyphaema (blood in the anterior chamber of the eye).
      • A distorted pupil.
      • Suspected damage to the retina.
      • Deep laceration of the orbit.
      • Subconjunctival haemorrhage.
      • Any lacerations.
  • Remove foreign body if present (and appropriate), see Removing a corneal foreign body.
  • Offer paracetamol or ibuprofen for pain relief.
  • To prevent secondary infection prescribe:
    • Topical chloramphenicol first-line for 7 days.
    • Consider prescribing fusidic acid (7 days) as an alternative.
  • Follow up:
    • Re-examine the eye after 24 hours with fluorescein:
      • If the corneal abrasion is reducing in size, re-examine daily to confirm that the abrasion is healing. If it has not healed after 72 hours, refer urgently to specialist eye services in secondary care.
      • If the corneal abrasion is not reducing in size, refer urgently to secondary care.
  • Any worsening symptoms such as increased pain or reduced visual acuity should prompt a thorough re-examination for a foreign body, and an urgent referral to the emergency eye service.

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