What is the most likely diagnosis for a man who experienced a strange sensation in his eyes, inability to open his eyes, epithelial line detachment, and unclear vision after cutting wood without eye protection (eye protective gear)?

Corneal Abrasion

The most likely diagnosis is B. Corneal abrasion, given the mechanism of injury (wood cutting without eye protection), acute foreign body sensation, inability to open the eye, epithelial line detachment, and blurred vision. 1, 2

Clinical Reasoning

The presentation strongly indicates a traumatic corneal abrasion based on several key features:

• Mechanism of injury: Wood cutting without protective eyewear is a classic high-risk scenario for corneal injury from flying wood particles or debris 1, 3
• Epithelial line detachment: This specific finding is pathognomonic for corneal abrasion, representing disruption of the corneal epithelium 2
• Classic symptom constellation: Foreign body sensation, inability to open the eye (blepharospasm), and blurred vision are the hallmark triad of corneal abrasion 2
• Acute onset: Symptoms began immediately after the traumatic event, consistent with mechanical epithelial injury 1

Why Not the Other Options

Corneal ulcer (Option A) is unlikely because:

• Ulcers typically develop over days to weeks, not acutely after trauma 2
• They require infection or underlying epithelial defect with secondary bacterial invasion
• The immediate post-trauma presentation argues against this diagnosis

Conjunctival hemorrhage (Option C) is definitively excluded because:

• Hemorrhage does not cause epithelial line detachment 1
• It does not typically impair vision or cause severe foreign body sensation
• The described epithelial pathology is inconsistent with simple hemorrhage

Immediate Management Priorities

This patient requires urgent ophthalmologic evaluation given the high-velocity mechanism (wood chopping) and vision changes 1. The American Heart Association and American Red Cross guidelines specifically mandate immediate medical attention for:

• High-velocity eye injuries from machinery or woodworking 1
• Loss of vision after trauma 1
• Persistent foreign-body sensation 1

Critical Assessment Steps

The ophthalmologist must perform 1, 2:

• Visual acuity testing to document baseline vision
• Fluorescein staining under cobalt-blue light to confirm epithelial defect and map its extent 2
• Slit-lamp examination to rule out embedded foreign body, which occurs in approximately 50% of ED presentations for ocular foreign bodies 1
• Careful eversion of upper eyelid to exclude retained foreign material
• Assessment for penetrating injury, particularly given the high-velocity mechanism 1

Treatment Algorithm

Initial management 2:

• Remove any visible foreign body if superficial and easily accessible
• Topical NSAIDs (e.g., ketorolac) for pain control, which are superior to patching 2
• Topical antibiotics to prevent secondary infection during epithelial healing 2
• Oral analgesics (acetaminophen or NSAIDs) for additional pain control 1

What NOT to do 1, 2:

• Do not patch the eye - multiple well-designed studies demonstrate patching does not help and may hinder healing 2
• Do not use topical mydriatics - they provide no benefit 2
• Do not allow eye rubbing - this worsens epithelial injury 1

Expected Course and Follow-up

Most corneal abrasions heal within 24 to 72 hours and rarely progress to corneal erosion or infection 2. However, this patient requires close follow-up because:

• The mechanism (wood particles) carries risk of retained organic foreign body 1, 4
• Vision changes mandate reassessment to ensure complete healing 1
• Failure to improve within 24-48 hours suggests retained foreign body or secondary infection 2, 4

Common Pitfalls

Missing an embedded foreign body: Translucent wood particles can be difficult to visualize and may become epithelialized over time, causing delayed symptoms 4. High index of suspicion is essential with woodworking injuries 3, 4.

Underestimating injury severity: While simple abrasions are common, the high-velocity mechanism of wood chopping can cause deeper penetrating injuries requiring more aggressive intervention 1, 3.