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  • • Suspected corneal abrasion.

    • History of eye trauma, prolonged use of contact lenses, or irritability in a nonverbal patient.

    • Abnormal vision.

    • • Decreased visual acuity.

      • Diplopia.

    • Abnormal sensation.

    • • Eye pain.

      • Photophobia.

      • Foreign body sensation.

    • Abnormal appearance.

    • • Blepharospasm.

      • Tearing.

      • Conjunctival erythema.

      • Visible corneal defect.

      • Visible corneal foreign body.

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Absolute

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  • • Penetrating trauma with suspected globe rupture.

    • Chemical burn.

    • Retained contact lens.

    • Hypersensitivity to fluorescein.

    • Eye patching of an abrasion caused by a contact lens or a contaminated surface is contraindicated due to increased risk of infection.

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Relative

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  • • Suspected minor chemical burn.

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  • • Examination gloves.

    • Sterile isotonic irrigation solution (0.9% saline or lactated Ringer’s). Copious tap water at room temperature is an acceptable alternative to prevent treatment delay.

    • Topical ophthalmic anesthetic solution (proparacaine 0.5% or tetracaine 0.5%).

    • Fluorescein dye (single-dose dropper or dye-impregnated ophthalmic paper strip).

    • Cobalt blue light (handheld direct ophthalmoscope or slit lamp) or ultraviolet light (Wood’s lamp).

    • Eye patch (occlusive or standard).

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  • • Hypersensitivity reaction to fluorescein.

    • Permanent fluorescein staining of a contact lens.

    • Iatrogenic corneal abrasion if fluorescein strip touches the eye.

    • Eye patching may increase discomfort and risk of infection.

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  • • A corneal abrasion is a simple scratch limited to the corneal epithelial surface.

    • A corneal or conjunctival foreign body is irritating, and rubbing may lead to further abrasions.

    • Suspect an embedded eyelid foreign body when no object can be visualized and symptoms are persistent.

    • Copious irrigation and mechanical removal of a persistent foreign body is necessary to prevent further abrasions.

    • If possible, do not apply a topical ophthalmic anesthetic until a foreign body is visualized or you are confident that none is present.

    • • Patients can help localize a foreign body but sensation will be eliminated by the topical anesthetic.

      • Patient’s inability to feel increases the potential for abrasions since there is no further pain or apprehension with blinking, eye movement, or rubbing.

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  • • Apply topical ophthalmic anesthetic solution after foreign body has been visualized or ruled out to decrease pain and facilitate procedure and eye examination.

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  • • Age-appropriate positioning and restraint as necessary to complete eye examination.

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  • • The cornea is the transparent outermost layer that covers the iris and pupil of the eye. Cornea must remain transparent to refract light properly.

    • The corneal tissue is arranged in 5 layers:

    • • Epithelium: The outermost layer that contains sensory nerves and comprises about 10% of the cornea.

      • Bowman’s layer: The basement membrane for epithelial cells.

      • Stroma: Provides support and is primarily composed of water and collagen and comprises about 90% of the cornea.

      • Descemet’s membrane: Provides elasticity and is composed of collagen.

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