History and exam
Key diagnostic factors
common
presence of risk factors
Working in a high-risk environment and not wearing protective eye wear predisposes to foreign bodies entering the eye and causing corneal abrasions. Contact lens wearers and those with previous corneal abrasions are at increased risk.
eye pain
Patients typically report sudden onset of pain and foreign body sensation immediately after sustaining the injury. Corneal abrasion alone can give the feeling of a foreign body even if none is present.
tearing
Common symptom and part of the eye's protective reflex.
photophobia
Common symptom and may make eye examination difficult.
blurred vision
May be due to pain, photophobia, and excessive tearing rather than a true decrease in visual acuity.
ciliary flush
A ring of red or violet around the cornea.
Other diagnostic factors
common
presence of foreign body
Metallic, glass, or organic particles may cause corneal abrasions that present with severe ocular discomfort. They may also become lodged under the eyelid. The responsible foreign body may have spontaneously dislodged by the time of examination.
Finding a retained foreign body, or patient report of one, should prompt a search for accompanying corneal abrasions or erosion.
red reflex
This will back-light corneal defects or foreign bodies. On moving the examiner’s head, corneal defects will appear to move in the opposite direction.
uncommon
corneal opacity
Suggests infection.
rust ring
May remain after removal of a metal foreign body. Requires follow-up and removal in 1-2 days.
blepharospasm
Experienced by some patients with corneal abrasions will experience this.
Risk factors
strong
eye trauma
Trauma can be self-induced (e.g., by fingernails) or from external objects striking the eye (e.g., branches, tools, or chemical splashes).
foreign body in the eye
Pieces of rust, glass, or dust that become lodged under the eyelid are often responsible. They may have spontaneously dislodged by the time of presentation.
contact lens use
Typically sustained when a user removes lenses that have adhered to the corneal epithelium, which is then removed with the contact lens. Users are at increased risk if they inadvertently sleep with their lenses in place, or remove them when relatively dehydrated.
working in the automotive industry
Among US automobile workers, an annual incidence of 15 work-related eye injuries per 1000 employees has been reported.[7] Corneal abrasions and superficial foreign bodies accounted for 87% of all ocular injuries.[7]
Occupations that involve grinding, cutting, and construction are likely to have a higher incidence of eye trauma due to an increased potential for foreign bodies to enter the eye.
lack of protective eyewear
prior corneal abrasion
Previous corneal abrasions with subsequent damage to the epithelium increase the risk for recurrent corneal erosions.[5] Structural defects in the epithelium and underlying basement membrane place the eye at greater risk. Patients typically report onset of symptoms in the morning when they first open their eyes.[5]
weak
deployment of airbag during motor vehicle collision
Motor vehicle collisions with frontal airbag deployment may increase the proportion of minor eye injuries, including corneal abrasions, but decrease the overall incidence of severe eye injury.[6]
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