Corneal abrasionMANAGEMENT

OPHTHALMOLOGIC PRESENTATIONS · 12 SECTIONS

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397 items

☷ Legend

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Cardiovascular Presentations71▾

Respiratory Presentations52▾

Neurological Presentations83▾

Gastrointestinal Presentations74▾

Genitourinary and Reproductive Presentations48▾

Infectious Disease Presentations148▾

Trauma Presentations89▾

Toxicologic Presentations80▾

Psychiatric Presentations26▾

Musculoskeletal and Rheumatologic Presentations96▾

Dermatology Presentations23▾

Environmental and Exposure Presentations27▾

Hematologic and Oncologic Presentations36▾

Pediatric-Specific Presentations19▾

Endocrine and Metabolic Presentations45▾

ENT and Maxillofacial Presentations27▾

Ophthalmologic Presentations19▾

Acute angle-closure glaucoma Central retinal artery occlusion Central Retinal Vein Occlusion Chemical eye injury Corneal abrasion Corneal ulcer Endophthalmitis Globe rupture Herpes zoster ophthalmicus Hyphema Iritis-Uveitis Ocular foreign body Optic Neuritis Orbital cellulitis Orbital Floor Fracture (Blowout)Posterior vitreous detachment Retinal detachment Retrobulbar hematoma and orbital compartment syndrome Vitreous Hemorrhage

Obstetric Presentations23▾

Systemic and Miscellaneous Presentations17▾

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

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

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

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

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

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

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

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

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 August 18, 2026

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