For information about the SORT evidence rating system, see page 957 or = consistent, good-quality patient-oriented evidence; B = inconsistent or limited-quality patient-oriented evidence; C = consensus, disease-oriented evidence, usual practice, expert opinion, or case series.
For information about the SORT evidence rating system, see page 957 or advance, and perform irrigation in the event of a chemical burn.
If symptoms and the abrasion improve after one day, reevaluate in two or three days.
Refer the patient to an ophthalmologist for any of the following scenarios: a small- to moderate-sized abrasion has not resolved by the third day; the cornea has not improved at any of the follow-up examinations; symptoms do not decrease each day; or the edge of the abrasion is white or gray, which may indicate infection.7Progression to recurrent corneal erosion (i.e., breakdown of the corneal epithelium) may occur years after a corneal abrasion.
The tray should be prepared in advance in case of an eye injury.
Eye patching does not improve cornea reepithelialization or discomfort from corneal abrasions.
Eye pain after a trauma caused by a foreign body, rubbing, or a scratch suggests a corneal abrasion.
Associated symptoms may include blinking, tearing, pain with eye movement, headache, blurry vision, and foreign body sensation.
Erythromycin and bacitracin (AK-tracin) are preferred over gentamicin (which may be toxic to corneal epithelium) and Neosporin (which has a relatively high allergic reaction rate).4Studies have shown that eye patching does not improve corneal reepithelialization or discomfort and increases pain in one half of patients.57 The addition of a topical nonsteroidal anti-inflammatory drug (NSAID; e.g., ketorolac [Acular], diclofenac [Voltaren]) has been shown to be somewhat beneficial for symptom relief7 and for decreasing narcotic use and time off work; however, NSAIDs may delay healing.8 Mydriatic agents are no longer recommended to treat corneal abrasions because they offer no additional benefit.9 Regardless of the ocular agents used, always offer oral analgesics because pain may be severe.
Advise the patient to avoid wearing contact lenses until the abrasion is healed and symptoms are resolved.
As laser use increases in industry and medical settings, adequate personal protection is needed to prevent cataracts.
Outdoor workers exposed to significant ultraviolet rays need sun protection and safety counseling to prevent age-related macular degeneration.
Remove minor irritants by irrigating the eye with eyewash solution.