COMMENTARY

Corneal Abrasions: Managing a Commonly Occurring Injury

Ronald C. Gentile, MD; David C. Ritterband, MD; Anaïs L. Carniciu

Disclosures

December 18, 2014

In This Article

Frequently Encountered, Highly Treatable

Corneal abrasions, also known as "scratches on the eye," occur when the epithelium of the cornea is injured, most often owing to mechanical trauma. Because of the cornea's densely layered pain fibers and therefore considerable sensitivity, these abrasions are regarded as one of the most painful ocular injuries. The unique physiology of the cornea also leaves it vulnerable on several fronts, which results in corneal abrasions being one of the most common diagnoses encountered by first-line practitioners and ophthalmologists.

The ability of the corneal epithelium to regenerate and a wide variety of currently available treatment options combine to make these injuries relatively free of long-term complications. However, knowing the relevant epidemiologic and anatomical details behind these injuries, along with proper management, will greatly aid practitioners in obtaining successful outcomes.

Epidemiology of Corneal Abrasions

Incidence. Corneal abrasions are commonly encountered by primary care physicians and are a leading cause of referrals to ophthalmologists. A National Ambulatory Medical Care Survey revealed that eye complaints constituted 2% of all patient visits to primary care physicians, of which conjunctivitis and corneal abrasions accounted for just over one half of all eventual diagnoses.[1]

Even though many corneal abrasions are seen in an ambulatory setting, inpatient consultations to an ophthalmologist for corneal abrasions are also very common. In one study conducted at a large university teaching hospital, corneal abrasions were one of the top five primary diagnoses referred for ophthalmic consultation.[1]

Mechanism. Corneal abrasions are most commonly due to mechanical causes related to the transfer of kinetic energy from an external object that overwhelms the adhesive force of the corneal epithelium. In adults, the main causes (in descending order) are foreign bodies, paper cuts, tree branches, fingers, hair brushes/combs, rocks, pens/pencils, and various toys.[2] The causes are similar in children with the exception of foreign bodies; these occur much less frequently among children, probably because foreign bodies most often occur in occupational settings.[3] Other causes of injury to the corneal epithelium include chemical, thermal/cryo, radiation, and dehydration or exposure injury. A variety of dystrophies, degenerations, or other abnormalities of the cornea may also cause spontaneous corneal erosions.

Given that mechanical injury to the corneal epithelium may penetrate further into eye, more serious ocular injuries should also be sought and properly identified if present.

Risk factors. Risk factors for corneal abrasions include anything that increases the chance of injury by either impairing the eye's ability to protect itself from external injury or by exposing it to abnormal stresses. Such risk factors include inadequate eye closure, reduced basal tear production, abnormal lid position, corneal neuropathy, extended contact lens use, and occupational or environmental exposures.

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