Corneal abrasionMANAGEMENT

OPHTHALMOLOGIC PRESENTATIONS · 12 SECTIONS

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397 items

☷ Legend

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Cardiovascular Presentations66▾

Respiratory Presentations47▾

Neurological Presentations77▾

Gastrointestinal Presentations63▾

Genitourinary and Reproductive Presentations44▾

Infectious Disease Presentations146▾

Trauma Presentations88▾

Toxicologic Presentations67▾

Psychiatric Presentations25▾

Musculoskeletal and Rheumatologic Presentations89▾

Dermatology Presentations21▾

Environmental and Exposure Presentations26▾

Hematologic and Oncologic Presentations30▾

Pediatric-Specific Presentations13▾

Endocrine and Metabolic Presentations42▾

ENT and Maxillofacial Presentations21▾

Ophthalmologic Presentations15▾

Acute angle-closure glaucoma Central retinal artery occlusion Central Retinal Vein Occlusion Chemical eye injury Corneal abrasion Corneal ulcer Globe rupture Hyphema Iritis-Uveitis Ocular foreign body Optic Neuritis Orbital cellulitis Orbital Floor Fracture (Blowout)Retinal detachment Vitreous Hemorrhage

Obstetric Presentations17▾

Systemic and Miscellaneous Presentations15▾

01Approach to the Critical Patient/attcp44

Immediate threats and exclusions

›Time-critical exclusions

›Open globe concern

›Severe decrease in visual acuity

›Irregular or peaked pupil

›Hyphema

›Extruded ocular contents

›Seidel positive

›If open globe concern, rigid eye shield

›If open globe concern, NPO

›If open globe concern, emergent ophthalmology

›Chemical ocular injury

›Alkali exposure

›Unknown chemical exposure

›If chemical injury, immediate irrigation before full exam

›If chemical injury, continue irrigation to neutral pH

›Penetrating or intraocular foreign body risk

›Metal-on-metal mechanism

›High-velocity projectile mechanism

›If high-risk mechanism, CT orbit without contrast

Initial stabilization and pain control

›Immediate priorities

›Visual acuity before drops when feasible

›Any acute decline from baseline

›If unable due to pain, after analgesia

›Pain control strategy

›Topical NSAID consideration for short course

›Oral analgesics if needed

›Cycloplegia for large abrasion or traumatic iritis features

›Infection risk recognition

›Contact lens related abrasion

›Organic matter trauma

›Immunocompromised host

Key decision points

›Management branch points

›Simple corneal abrasion

›Normal or near-normal visual acuity

›No infiltrate or ulcer

›No hypopyon

›Negative Seidel

›Complicated abrasion

›Central visual axis involvement

›Large defect

›Persistent symptoms beyond 24-48 hours

›Contact lens wear

›Suspected herpetic keratitis pattern

›If complicated features, urgent ophthalmology follow-up

02History/hx39

Mechanism and symptom profile

›Presenting features

›Eye pain

›Foreign body sensation

›Worse with blinking

›Photophobia

›Direct photophobia

›Consensual photophobia

›Tearing

›Excess lacrimation

›Discharge quality

›Visual symptoms

›Blurry vision

›Diplopia

Risk factors and exposures

›Predisposing factors

›Contact lens wear

›Overnight wear

›Extended-wear lenses

›Recent swimming or hot tub exposure

›Trauma details

›Metal grinding

›Vegetation or soil exposure

›Fingernail injury

›Ocular history

›Prior corneal abrasion

›Recurrent corneal erosion history

›Prior ocular surgery

›Infectious risks

›Herpes simplex history

›Recent conjunctivitis exposure

Red flags

›High-risk symptoms

›Marked vision loss

›New inability to read large print

›New inability to count fingers

›Severe headache with eye pain

›Nausea or vomiting

›Halos around lights

›Severe photophobia out of proportion

›Consider uveitis

›Consider keratitis

03Physical Exam/exam39

Core eye exam

›Baseline assessment

›Visual acuity

›Documented with correction status

›Any reduction compared to baseline

›Pupils

›Shape regularity

›Relative afferent pupillary defect

›Extraocular movements

›Pain with movement

›Movement restriction

›External inspection

›Lid laceration

›Conjunctival injection pattern

Slit lamp and fluorescein findings

›Corneal assessment

›Fluorescein uptake pattern

›Abrasion size in mm

›Central versus peripheral location

›Seidel test result

›If positive, open globe pathway

›If negative, proceed with abrasion care

›Foreign body evaluation

›Tarsal plate eversion finding

›Rust ring concern

›Corneal infiltrate or ulcer

›Focal stromal opacity

›Overlying epithelial defect

Associated findings and pitfalls

›Complication screen

›Traumatic iritis features

›Consensual photophobia

›Cells and flare

›Hyphema

›Layering blood in anterior chamber

›If present, urgent ophthalmology

›Herpetic keratitis suspicion

›Dendritic fluorescein uptake

›Reduced corneal sensation

›PITFALLS

›Normal-appearing cornea without fluorescein in early symptoms

›Contact lens wearer with subtle infiltrate representing early microbial keratitis

04Differential Diagnosis/ddx31

Ocular surface and anterior segment

›Key alternatives

›Corneal foreign body (T15.0)

›Persistent focal discomfort

›Vertical linear abrasions

›Microbial keratitis or corneal ulcer (H16.0)

›Corneal infiltrate

›Purulent discharge

›Contact lens risk

›Herpes simplex keratitis (B00.52)

›Dendritic lesion

›Recurrent episodes

›Traumatic iritis (H20.0)

›Consensual photophobia

›Cells and flare

›Acute angle-closure glaucoma (H40.21)

›Mid-dilated pupil

›High intraocular pressure

Traumatic and vision-threatening causes

›Vision-threatening diagnoses

›Open globe injury (S05.3)

›Seidel positive

›Irregular pupil

›Orbital fracture (S02.3)

›Diplopia

›Infraorbital numbness

›Retrobulbar hemorrhage (H05.23)

›Proptosis

›Reduced vision

›Tight orbit

›Endophthalmitis (H44.0)

›Postoperative history

›Severe pain and reduced vision

05Laboratory Tests/lt14

Routine labs

›Laboratory testing strategy

›No routine labs for simple corneal abrasion

›Normal vital signs

›No systemic infection concern

›If systemic infection or immunocompromised concern, targeted labs

›Complete blood count for fever or cellulitis concern

›C-reactive protein for severe orbital inflammation concern

Microbiology

›Culture considerations

›Corneal culture indications

›Suspected microbial keratitis

›Large central infiltrate

›Immunocompromised host

›If culture indicated, ophthalmology-directed sampling

›Avoid delaying antibiotics when high-risk ulcer suspected

06Diagnostic Tests/dt40

Scoring Systems

›Risk stratification framework

›Simple abrasion criteria

›No contact lens wear

›No corneal infiltrate

›Normal or near-normal visual acuity

›Negative Seidel

›Small defect 4 mm or less

›Urgent ophthalmology criteria

›Contact lens wear

›Corneal infiltrate or ulcer

›Hypopyon

›Central visual axis involvement

›Reduced visual acuity

›Suspected herpetic keratitis pattern

MRI

›MRI role

›Limited role in isolated corneal abrasion

›Not first-line for foreign body

›Not first-line for orbital fracture

›If concern for orbital apex or cavernous sinus process, specialty-directed imaging

›Ophthalmology or neurology consultation

›Persistent cranial nerve deficits

›CT indications

›CT orbit without contrast

›Suspected intraocular or intraorbital foreign body

›High-velocity mechanism

›CT facial bones or orbit

›Suspected orbital fracture

›Diplopia with gaze limitation

›CT findings escalation

›Foreign body identified, emergent ophthalmology

›Globe contour abnormality, open globe pathway

Ultrasound

›Ultrasound considerations

›Point-of-care ocular ultrasound

›Not needed for isolated abrasion

›Useful for retinal detachment concern when no globe rupture concern

›Contraindications

›If open globe concern, avoid ocular ultrasound

›If used

›Retinal detachment signs

›Vitreous hemorrhage signs

07Disposition/dispo25

Follow-up timing and level of care

›Disposition planning

›Outpatient management candidates

›Simple abrasion criteria met

›Pain controlled

›Reliable follow-up access

›Re-evaluation window

›24 hours if contact lens wear

›24 hours if large defect

›24 hours if reduced visual acuity

›24-48 hours if symptoms not improving

Admit, transfer, or emergent consultation

›Escalation triggers

›Emergent ophthalmology

›Open globe concern

›Corneal ulcer or infiltrate

›Hyphema

›Hypopyon

›Suspected herpetic keratitis

›Transfer consideration

›No local ophthalmology access with high-risk features

›Intraocular foreign body concern

›Return precautions that override outpatient plan

›Worsening pain

›New vision loss

›Increasing discharge

›Increasing photophobia

08Treatment/t67

Foreign body and surface care

›Surface management

›Foreign body removal

›Superficial conjunctival or corneal foreign body

›If embedded or central visual axis, ophthalmology

›Rust ring, ophthalmology or skilled removal

›Lubrication support

›Preservative-free artificial tears

›Frequent use for comfort

›Nighttime ointment option

Topical antibiotics

›Antimicrobial prophylaxis

›Non-contact lens abrasion

›Erythromycin 0.5% ophthalmic ointment

›1 cm ribbon QID for 3-5 days

›Stop when symptom-free for 24 hours

›Polymyxin B trimethoprim drops

›1 drop QID for 3-5 days

›Ointment preferred if significant discomfort

›Contact lens related abrasion

›Ofloxacin 0.3% drops

›1-2 drops QID for 3-5 days

›Continue until symptom-free for 24 hours

›Ciprofloxacin 0.3% drops

›1-2 drops QID for 3-5 days

›Alternative to ofloxacin

›Contact lens cessation

›No lens wear until fully healed and symptom-free

›Replace lenses and case after infection-risk event

Analgesia and inflammation control

›Pain control options

›Oral analgesics

›Acetaminophen 1000 mg PO every 6 hours as needed

›Maximum 4000 mg per day

›Lower maximum if liver disease

›Ibuprofen 400 mg PO every 6 hours as needed

›Maximum 2400 mg per day typical ED guidance

›Avoid in significant renal disease or GI bleed risk

›Topical NSAID short course

›Ketorolac 0.5% drops

›1 drop QID for up to 48 hours

›Avoid prolonged use due to corneal toxicity risk

›Cycloplegic for traumatic iritis features

›Cyclopentolate 1% drops

›1 drop TID as needed for photophobia

›Avoid in narrow-angle glaucoma risk

Topical anesthetic for home use

›Topical anesthetic outpatient protocol

›ACEP consensus guideline 2024

›Level B recommendation for simple corneal abrasions in adults

›Commercial topical anesthetic up to every 30 minutes as needed for 24 hours

›Total dispensed volume 1.5 to 2 mL

›Discard remainder after 24 hours

›Exclusions for outpatient anesthetic

›Contact lens wear

›Suspected infection or corneal ulcer

›Any abnormal corneal exam beyond abrasion

›Pediatric patients

›Interdisciplinary controversy

›Ophthalmology concerns regarding toxicity and misuse

›Shared decision-making and strict limits

Therapies to avoid

›Avoided practices

›Eye patching for simple abrasion

›No improvement in healing or pain in systematic reviews

›Increased infection concern in contact lens wear

›Topical corticosteroids without ophthalmology

›Delayed epithelial healing

›Increased infection risk

›Topical anesthetic beyond 24 hours

›Corneal toxicity risk

›Masked worsening infection risk

09Special Populations/sp30

Pregnancy

›Pregnancy considerations

›Medication safety

›Erythromycin ophthalmic ointment generally preferred

›Avoid systemic NSAIDs in third trimester

›Pain control choices

›Acetaminophen preferred first-line

›Ophthalmology input for suspected infection

›Follow-up thresholds

›Lower threshold for ophthalmology with vision symptoms

›Avoid delayed care with suspected keratitis

Geriatric

›Older adult considerations

›Healing and risk

›Slower epithelial healing potential

›Higher dry eye prevalence

›Medication risks

›NSAID adverse effects higher risk

›Polypharmacy interaction review

›Alternate diagnoses

›Higher suspicion for herpetic keratitis with atypical pain

›Higher suspicion for angle closure with headache symptoms

Pediatrics

›Pediatric considerations

›Exam limitations

›Visual acuity may be difficult to obtain

›Foreign body under lid more common with rubbing

›Medication dosing and adherence

›Ointment easier than drops for many children

›Avoid outpatient topical anesthetic

›Escalation triggers

›Any concern for penetrating trauma

›Nonverbal child with persistent distress

10Background/b30

Epidemiology

›Frequency and natural course

›Common ED ocular complaint

›Often trauma-related

›Often foreign body related

›Healing timeline for uncomplicated abrasion

›Many heal within 24-72 hours

›Larger defects slower healing

Pathophysiology

›Mechanism

›Corneal epithelium disruption

›Exposed nerve endings causing pain

›Reflex tearing and photophobia

›Infection risk pathways

›Epithelial defect allows microbial entry

›Contact lens biofilm and Pseudomonas risk

›Recurrent corneal erosion mechanism

›Defective epithelial adhesion after prior injury

›Morning pain episodes with lid opening

Therapeutic Considerations

›Rationale for key therapies

›Topical antibiotics

›Superinfection prevention goal

›Antipseudomonal coverage for contact lens wearers

›Pain control selection

›Topical NSAID reduces inflammatory pain

›Cycloplegia reduces ciliary spasm pain in iritis

›Patching avoidance

›No consistent pain reduction benefit

›Possible delayed healing and infection concerns

›Topical anesthetic restricted use

›Short course safety signal in selected adults

›Toxicity risk with prolonged or unsupervised use

11Patient Discharge Instructions/pdi21

copy discharge instructions

›Discharge plan

›Medication use

›Antibiotic regimen as prescribed

›Pain control with oral analgesics or topical NSAID if prescribed

›No contact lenses until fully healed and symptom-free

›Activity guidance

›Avoid eye rubbing

›Protective eyewear for high-risk activities

›Avoid swimming or hot tubs during healing if contact lens related

›Return to ED now

›Worse pain

›New or worsening vision loss

›Increasing redness or swelling

›Increasing discharge

›Fever or facial pain

›Severe headache with nausea or halos

›Follow-up

›24 hours for contact lens related abrasion

›24 hours for reduced vision

›24 hours for large or central abrasion

›48 hours if not improving as expected

12References/r17

Clinical guidelines and evidence sources

›Key references

›American College of Emergency Physicians consensus guideline 2024 on topical anesthetic home use for simple corneal abrasions

›Level B recommendation limits

›24-hour maximum use

›American Academy of Ophthalmology educational guidance on topical anesthetic risks

›Toxicity and misuse concerns

›Preference for supervised use only

›Cochrane review on eye patching for corneal abrasion

›No clear benefit for pain control

›No clear benefit for faster healing

Point-of-care clinical summaries

›Secondary references

›NCBI Bookshelf StatPearls Corneal Abrasion updated 2024

›Antipseudomonal antibiotics for contact lens wearers

›Typical ointment and drop regimens

›American Family Physician review on corneal abrasion evaluation and follow-up

›Follow-up thresholds for uncomplicated abrasions

›Antipseudomonal coverage for contact lens related abrasions

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Reviewed by SymptomDx Medical Team · Last reviewed June 16, 2026

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