Corneal Abrasion

A corneal abrasion is a scratch or scrape on the cornea — the clear, dome-shaped “windshield” that focuses light into your eye. Because the cornea contains more sensory nerve endings than almost any other tissue in the body, even a hairline defect can feel dramatic. Most superficial scratches heal in one to three days, but deeper injuries can scar, trigger infection, or permanently blur vision if treatment is delayed.[1] Globally, corneal trauma is among the top causes of preventable monocular blindness, underscoring the importance of prompt evaluation.[2]

The cornea also acts as a barrier against dirt, germs, and chemicals. A breach offers microbes a doorway to the delicate inner eye, so clinicians focus on both closing the scratch and preventing microbial keratitis—an aggressive infection that can develop within 24 hours. Standard care combines preservative-free lubrication to speed epithelial migration, a topical antibiotic to curb infection risk, and pain control so patients avoid rubbing the eye.[3]

Symptoms often appear within minutes and can be severe even for tiny abrasions:

• Sudden sharp pain that worsens with blinking
• Foreign-body sensation (the feeling something is in the eye)
• Redness and excessive tearing
• Blurred or hazy vision
• Light sensitivity (photophobia)
• Headache or eyelid twitching

Pain that intensifies over 12 hours, thick discharge, or a sudden drop in vision can signal infection or a deeper wound and requires same-day ophthalmic care.[4][5]

Almost anything that touches the ocular surface can cause an abrasion, but common culprits include:

1. Traumatic objects — fingernails, make-up brushes, paper edges, pet claws, plant branches.
2. Foreign bodies — wind-blown sand, metal filings, sawdust.
3. Contact-lens misuse — sleeping in lenses or poor hygiene.[6]
4. High-velocity particles from grinding, mowing, or welding without ANSI-approved eyewear.
5. Dry-eye disease or incomplete eyelid closure (lagophthalmos).

Sports such as basketball, racquetball, and hockey also rank high for ocular injuries; properly fitted polycarbonate sports goggles dramatically cut risk.[7] A 2024 review found that eye protection prevented up to 90 % of game-related corneal abrasions.[8]

An eye-care professional will:

• Take a focused history (mechanism, timing, contact-lens use).
• Instill anesthetic drops to allow gentle eyelid opening.
• Apply fluorescein dye; under blue light, the scratch glows bright green.
• Invert the upper lid to rule out a trapped foreign body.
• Use slit-lamp biomicroscopy to gauge size, depth, and location.

Defects limited to the epithelium and <6 mm usually heal rapidly; deeper or central lesions, organic-matter injuries, or those in contact-lens wearers warrant daily follow-up and sometimes cultures.[3][9]

Goals: speed re-epithelialization, prevent infection, relieve pain.

1. Lubrication

Preservative-free artificial tears every 1–2 hours reduce lid–wound friction and facilitate healing.

2. Antibiotic prophylaxis

Broad-spectrum topical antibiotics (e.g., erythromycin ointment or moxifloxacin drops) 4–6× daily until the defect closes.[10]

3. Pain control

Oral NSAIDs, short-course topical NSAIDs, or cycloplegic drops reduce ciliary spasm. A bandage contact lens can halve pain but necessitates close monitoring.

4. Tetanus update

Give if wound caused by soil-contaminated object and vaccination is outdated.

5. Follow-up

Re-examine within 24 hours; 90 % of simple abrasions close by then. Non-healing defects may indicate retained foreign body, irregular edges, or early infection requiring fortified antibiotics or amniotic-membrane therapy.[11]

During healing, avoid eye rubbing, contact lenses, and eye make-up. Wear sunglasses if light hurts. To prevent future abrasions:

1. Protective eyewear: ANSI Z87.1 safety glasses prevent up to 90 % of occupational eye injuries.
2. Contact-lens hygiene: Replace cases every three months, rub-and-rinse lenses, never swim or shower in lenses.
3. Treat dry eye: Warm compresses, omega-3 supplements, and prescription anti-inflammatories reduce friction-related micro-abrasions.

Innovations aim to accelerate healing and minimize complications:

• Recombinant lubricin drops cut epithelial-closure time by ~30 % in a 2023 randomized trial.[14]
• Smart bandage lenses embedded with antibiotic-growth-factor micro-reservoirs received $6.7 million in new NEI funding to enter phase II trials.[15]
• Limbal stem-cell patches are being tested for recurrent erosion, with early reports of reduced episodes and better vision.
• Handheld anterior-segment OCT now allows bedside measurement of defect depth within microns, guiding more tailored therapy.

Best specialist: a cornea and external-disease ophthalmologist. They have high-magnification microscopes, debridement tools, and access to advanced biologic therapies.

Scheduling tips: Start with urgent care or an optometrist for initial evaluation; ask for an expedited cornea referral if pain worsens after 24 hours, vision declines, or the injury involves contact-lens wear. Many hospital-based eye institutes reserve same-day “cornea walk-in” slots for acute injuries.[1][2]