Chapter 50. Corneal Abrasion and Eye Patching

• • 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.

Absolute

• • 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.

Relative

• • Suspected minor chemical burn.

• • 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).

• • 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.

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

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

• • Figure 50–1 shows the anatomy of the eye.

• • 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 ...