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CLINICAL MANAGEMENT GUIDELINES
Corneal abrasion
Aetiology
Loss of corneal epithelial tissue due to:
 sub-tarsal foreign body
 trauma (e.g. fingernail, twig, edge of paper, mascara brush)
 contact lens related trauma
 trichiasis (e.g. lash contact in entropion)
Predisposing
Contact lens wear
factors
Corneal dystrophy
 Epithelial Basement Membrane (EBM) dystrophy, in which epithelium is
abnormal and easily traumatised
Corneal exposure
 dry eye
 lagophthalmos
 facial palsy
Diabetes
Neurotrophic keratitis
Symptoms
Pain
 ranges from mild foreign body sensation to severe pain; may be
disproportionate to objective findings
 absence of pain should alert to possibility of neurotrophic keratitis
Blepharospasm
Photophobia
Lacrimation
Redness
History of trauma
Signs
Vary according to severity of trauma
Lid oedema and erythema
Conjunctival hyperaemia
Corneal epithelial defect (stains with fluorescein)
Corneal oedema beneath defect
Visual loss (due to epithelial disruption and stromal oedema)
Possible secondary anterior uveitis (anterior ciliary injection, cells, flare)
Differential
Infectious keratitis (all forms)
diagnosis
Recurrent corneal erosion
Spontaneous epithelial breakdown in EBM Dystrophy (see Clinical
Management Guideline on Recurrent Erosion Syndrome)
Photokeratitis (see Clinical Management Guideline on Photokeratitis)
Management by Optometrist
Practitioners should recognise their limitations and where necessary seek further advice or refer
the patient elsewhere
Non
Determine how the injury was caused. In particular rule out chemical injury
pharmacological and penetrating trauma
Evaluate abrasion using fluorescein
 size (use length of slit beam) and location
 depth
 edge quality
 oedema beneath abrasion
 confirm no corneal foreign body present
If corneal foreign body present, see Clinical Management Guideline on Corneal
Foreign Body
Evaluate anterior chamber reaction
Evert eyelids to confirm no foreign body present
Corneal abrasion
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Date of search 07.12.14; Date of revision 26.03.15; Date of publication 28.05.15; Date for review 06.12.16
© College of Optometrists
CLINICAL MANAGEMENT GUIDELINES
Corneal abrasion
If sub-tarsal foreign body present, see Clinical Management Guideline on SubTarsal Foreign Body
Advise patient to return/seek further help if symptoms persist (potential for
development of Recurrent Epithelial Erosion Syndrome (see CMG on
Recurrent Epithelial Erosion Syndrome)
Advise on suitable eye protection
(GRADE*: Level of evidence=low, Strength of recommendation=strong)
For large abrasions, consider therapeutic contact lens fitting
(GRADE*: Level of evidence=low, Strength of recommendation=weak)
Do not patch eye
(GRADE*: Level of evidence=high, Strength of recommendation=strong)
Pharmacological
Topical anaesthetic (e.g. gutt. benoxinate 0.4%) if necessary to aid
examination
Systemic analgesia for first 24h (paracetamol, aspirin, or ibuprofen if no
contraindications; dosage as for headache)
(GRADE*: Level of evidence=low, Strength of recommendation=strong)
Ocular lubricants for symptomatic relief (drops for use during the day,
unmedicated ointment for use at bedtime)
(GRADE*: Level of evidence=low, Strength of recommendation=strong)
Also consider a topical NSAID for its analgesic and anti-inflammatory
properties, e.g. gutt. diclofenac 0.1% up to four times daily for 1-3 days
(GRADE*: Level of evidence=moderate, Strength of recommendation=strong)
If there is a possibility of infection, prescribe a broad spectrum topical antibiotic
e.g. chloramphenicol (NB risk of infection following mild trauma is low)
(GRADE*: Level of evidence=low, Strength of recommendation=weak)
For large abrasions or in associated iritis, consider cycloplegia to prevent pupil
spasm, e.g. gutt. cyclopentolate 1% twice daily until healed)
(GRADE*: Level of evidence=low, Strength of recommendation=weak)
B3: management to resolution
A2: if abrasion deep and/or contaminated with foreign material, or apparently
infected, refer as emergency (same day) to Ophthalmologist
Possible management by Ophthalmologist
Assess for secondary infection
Debridement if indicated
Therapeutic contact lens fitting
Plain X-ray or CT scan to exclude retained foreign body
Evidence base
*GRADE: Grading of Recommendations Assessment, Development and
Evaluation (see http://gradeworkinggroup.org/toolbox/index.htm)
Management
Category
Sources of evidence
Calder LA, Balasubramanian S, Fergusson D. Topical nonsteroidal antiinflammatory drugs for corneal abrasions: meta-analysis of randomized
trials. Acad Emerg Med. 2005;12(5):467-73
Meek R, Sullivan A, Favilla M, Larmour I, Guastalegname S. Is homatropine
5% effective in reducing pain associated with corneal abrasion when
compared with placebo? A randomized controlled trial. Emerg Med
Corneal abrasion
Version 10, Page 2 of 3
Date of search 07.12.14; Date of revision 26.03.15; Date of publication 28.05.15; Date for review 06.12.16
© College of Optometrists
CLINICAL MANAGEMENT GUIDELINES
Corneal abrasion
Australas. 2010;22(6):507-13
Turner A, Rabiu M. Patching for corneal abrasion. Cochrane Database of
Systematic Reviews 2006, Issue 2. Art. No.: CD004764. DOI:
10.1002/14651858.CD004764.pub2
Wipperman JL, Dorsch JN. Evaluation and management of corneal
abrasions. Am Fam Physician. 2013;87(2):114-20
LAY SUMMARY
Abrasions of the cornea (the clear window of the eye) are common, being usually caused by a
minor accidental injury, for example by a finger, mascara brush or contact lens, or by a speck of
foreign matter under the upper eyelid. There are also medical conditions that make abrasions more
likely, for example a condition, known as a dystrophy, in which the surface tissue of the cornea (the
epithelium) is more delicate than usual; also when the cornea is exposed by failure of the normal
blink reflex, or when its sensitivity to touch is reduced by damage to its nerves, as in diabetes or
following shingles of the eye. Corneal abrasion can be very painful as the cornea is one of the
most sensitive areas of the body.
The clinician will assess the area involved and prescribe treatment accordingly. The damage to the
surface can be seen more easily if fluorescein, an orange dye, is instilled into the eye. Antiinflammatory or antibiotic eye drops are often recommended, depending on the type and size of
abrasion. Dilating eye drops, to relax the pupil, are sometimes given. There is little evidence
supporting the use of these drugs.
Corneal abrasions usually heal quickly and completely but if the injury is deeper, or contaminated
by foreign material, or possibly infected, referral to an ophthalmologist is recommended.
Corneal abrasion
Version 10, Page 3 of 3
Date of search 07.12.14; Date of revision 26.03.15; Date of publication 28.05.15; Date for review 06.12.16
© College of Optometrists