An 8-year-old boy was poked in the eye with a small branch while hiking with his cub scout pack. He presented with pain, tearing, photophobia, and a foreign body sensation. Fluorescein application demonstrated a green area under cobalt-blue filtered light (Figure 11-1). Careful inspection with magnification, including eversion of the upper eyelid, revealed no foreign body. He was treated with antibiotic eye drops. He showed improvement the next day and over time had complete resolution.
Fluorescein stains green, indicating corneal abrasion. (Used with permission from Paul D. Comeau.)
Corneal abrasions are often the result of eye trauma and can cause an inflammatory response and significant pain. Corneal abrasions are detected using fluorescein and a UV light. A corneal foreign body can be seen during a careful physical examination with a good light source or slit lamp. Nonpenetrating foreign bodies can be removed by an experienced physician in the office using topical anesthesia. Refer all penetrating foreign bodies to an ophthalmologist.
Corneal abrasion is sometimes referred to as a corneal epithelial defect.
Corneal abrasion with or without foreign body is common; however, the prevalence or incidence of corneal abrasion in the general pediatric population is unknown.
Corneal abrasion is the most common eye injury for children presenting to an emergency room.1
Etiology and Pathophysiology
The cornea overlies the anterior chamber and iris and provides barrier protection, filters UV light, and refracts light onto the retina.
Abrasions in the cornea are typically caused by direct injury from a foreign body, resulting in an inflammatory reaction.
The inflammatory reaction causes the symptoms and can persist for several days after the foreign object is out. Typically in children, the corneal abrasion heals more rapidly than in adults.
Participation in sports such as hockey, lacrosse, or racquetball raises the risk of corneal abrasions from ocular trauma.2
Ventilated neonates (as a result of mask pressure on the orbit) or sedated patients (as a result of disruption of the blink reflex, and subsequent corneal exposure) are at increased risk for corneal abrasions.2
Contact lenses, especially soft extended wear, increase the risk of developing an infected abrasion that ulcerates.2 Any contact lens wearer with a corneal abrasion should see an ophthalmologist, due to the high risk of permanent vision loss due to infection.