Is a corneal abrasion considered a medical emergency?

Management of Corneal Abrasions: Emergency Assessment and Treatment

Corneal abrasions require prompt evaluation and treatment but are not typically considered medical emergencies unless there are specific concerning features present. 1

Assessment and Triage

Red Flags Requiring Immediate Ophthalmology Referral

• Penetrating eye injury
• Irregular pupil after trauma
• Eye bleeding
• Vision loss after trauma
• High-velocity injuries (grinding, nailing, machinery)
• Suspected corneal ulcer or bacterial keratitis
• Persistent foreign body sensation after irrigation 1

Initial Evaluation

• Visualize the cornea under cobalt-blue filtered light after fluorescein application to confirm diagnosis 2
• Assess for depth of abrasion and any signs of infection
• Evaluate for foreign bodies that may require removal

Immediate Management

1. Irrigation

   • Irrigate the eye with tap water or commercial eyewash solution to remove any loose foreign material 1
   • Avoid rubbing the eye as it can worsen the abrasion 1

2. Protection

   • Apply a hard plastic eye shield, paper cup, or plastic cup over the eye to prevent touching 1
   • Do not patch the eye - evidence shows patching does not improve healing and may increase infection risk 1, 3

3. Medication

   • Antibiotics: Apply topical broad-spectrum antibiotic drops (e.g., moxifloxacin 0.5%, gatifloxacin 0.3%) within 24 hours of injury 1
   • Pain management:
     • Oral analgesics (acetaminophen, NSAIDs) for pain relief 1
     • Topical NSAIDs can be considered for additional pain control 1
     • Avoid topical anesthetics for outpatient use - they delay healing and can lead to complications 1

4. Contact Lens Considerations

   • Remove contact lens immediately if present 1
   • Patients should not wear contact lenses during treatment 1

Follow-up Care

• Re-evaluate larger or complicated abrasions within 24 hours 1
• Most uncomplicated corneal abrasions heal within 24-72 hours 2
• Monitor for:
  • Complete re-epithelialization
  • Decrease in anterior chamber reaction
  • Resolution of pain and redness 1

Special Considerations

For Delayed Healing

• Consider bandage contact lens (with awareness of increased bacterial keratitis risk) 1
• Amniotic membrane may be helpful in cases of delayed healing 1

For Progressive Thinning or Small Perforations

• Apply tissue adhesive (cyanoacrylate) over a clean, dry base 1
• Fibrin glue is not recommended due to rapid biodegradation 1

Prevention

• Recommend protective eyewear for sports and high-risk activities 1
• Educate patients about signs requiring prompt consultation:
  • Increasing pain
  • Worsening vision
  • Purulent discharge
  • Lack of improvement within 48 hours 1

Common Pitfalls to Avoid

1. Patching the eye - multiple well-designed studies show patching does not help and may hinder healing 2, 3
2. Using topical anesthetics for outpatient treatment - delays healing and can cause complications 1
3. Using topical corticosteroids without antibiotic coverage - can worsen infection 1
4. Failing to recognize high-risk features requiring immediate ophthalmology referral 1, 4
5. Overlooking proper follow-up - especially for larger abrasions or those at risk for complications 1

Most corneal abrasions heal without complications when properly managed, but prompt assessment and appropriate treatment are essential to prevent potential sight-threatening consequences 4.