• Suspected corneal abrasion.
• History of eye trauma, prolonged use of contact lenses, or irritability
in a nonverbal patient.
• Abnormal vision.
• Abnormal sensation.
• Abnormal appearance.
• 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.
• 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
• Fluorescein dye (single-dose dropper or dye-impregnated ophthalmic
• Cobalt blue light (handheld direct ophthalmoscope or slit lamp)
or ultraviolet light (Wood’s lamp).
• Eye patch (occlusive or standard).
• 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.
• 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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