Corneal abrasion or scratch on the front of the eye can be extremely painful. The cornea is the window of the eye and is the circular transparent part that sits in front of the iris. The cornea is very richly supplied with very fine sensitive nerves to help protect it. It can easily be scratched by contact with dust, dirt, wood shavings, metal particles, contact lenses, edges of paper or fingernail or a sharp plant when it will feel very painful.
The superficial layer of the cornea is called the epithelium. A corneal abrasion is when the corneal epithelium is damaged by an object scratching it. The epithelium has about five layers of cells, and a scratch can be very superficial just taking off for instance just three or four layers or it can be deeper going away all of the epithelium down to its basement membrane.
A corneal abrasion can be very slight with just a few scratches, or it can be more extensive with a larger amount of the epithelium visibly lifted off. The larger the corneal abrasion is, the more painful it will be, but notwithstanding a small corneal abrasion is also very painful! If someone has a corneal abrasion, they are likely to have a red, painful tearing eye, which is sensitive to the light with a headache. There is an important differential diagnosis of these symptoms, which also includes uveitis, acute glaucoma, dendritic ulcer and infected corneal ulcer. So it is essential if you have symptoms of pain, tearing, redness, sensitivity to light and a foreign body sensation that you are urgently assessed by an ophthalmic specialist.
If someone has a corneal abrasion, they are likely to have a red, painful tearing eye, which is sensitive to the light with a headache. There is an important differential diagnosis of these symptoms, which also includes uveitis, acute glaucoma, dendritic ulcer and infected corneal ulcer. So it is essential if you have symptoms of pain, tearing, redness, sensitivity to light and a foreign body sensation that you should urgently visit an ophthalmic specialist.
If you cannot get to see an ophthalmic specialist urgently, and you think that something has gone in the eye, you should wash the eye out with clean water or saline solution using a cup or small clean drinking glass positioned on the rim of the orbit. Then you can pour the rinsing solution onto the eye. This may well wash out any foreign object, but there will likely still be a small scratch or abrasion present. If you think you have got a corneal abrasion, there are some don’ts as well. You should not rub the eye. You should not try to remove any foreign body, and you should not continue doing what you are doing, but you should seek medical advice.
Most corneal abrasions, especially from a sub-tarsal foreign body heal very rapidly within 24 hours to 48 hours. However, the diagnosis needs to be confirmed and the piece of grit removed from under the upper eyelid. If the corneal abrasion has involved the central part of the cornea, the vision can be temporarily affected and become blurred.
Treatment of the corneal abrasion involves first having a full assessment by the ophthalmologist who will examine the eyelids and the front of the eye after measuring the vision. They will check that there is no trapped foreign body underneath the eyelid or on the cornea. They will use fluorescein drops and topical anaesthesia to make it more comfortable and to see the scratches clearly when they look at the slit lamp.
If the doctor does not find the foreign body and it is just an abrasion, and there is no evidence of any infection, they may well put an eye pad on the eye for 12 hours to 24 hours to make it feel more comfortable. They will likely advise you to have some painkillers such as Paracetamol. They may put a dilating drop in the eye underneath the eye pad, which stops the ciliary spasm and pain and then they will give you some antibiotic eye drops or ointment to put in the eye four times a day for up to five days. They may want to see you again to see how it is healing, especially if it has been a significant corneal abrasion.
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