A corneal abrasion is a common and painful injury that occurs when the outermost layer of the eye’s clear, dome-shaped front surface, the corneal epithelium, is scratched or scraped away. This protective layer is highly sensitive due to nerve endings, causing significant discomfort, a feeling that something is stuck in the eye, and intense light sensitivity. Common causes include minor accidents like a fingernail poke, debris entering the eye, or contact lens misuse. Since the cornea is responsible for much of the eye’s focusing power, this surface injury can also lead to temporary blurry or hazy vision.
The Optometrist’s Role in Acute Eye Injuries
Optometrists function as primary eye care providers and are typically the first point of contact for patients suffering from acute eye injuries like a corneal abrasion. Their training and scope of practice include the ability to diagnose, manage, and treat such common traumatic conditions. An optometrist is equipped to handle the immediate care necessary to ensure proper healing and prevent complications.
Confirmation of a corneal abrasion begins with a thorough examination using a specialized instrument called a slit lamp. A non-toxic, orange dye called fluorescein is applied to the eye’s surface, pooling where the epithelial cells have been damaged. When viewed under the slit lamp’s cobalt blue filter, the abrasion glows bright green, outlining the size and shape of the injury. This diagnostic step allows the optometrist to measure the defect and rule out more severe issues, such as a penetrating injury or a retained foreign body.
Most non-complex corneal abrasions are successfully managed by an optometrist through medical treatments and close monitoring. Optometrists are trained to differentiate between a simple epithelial scratch and one that involves deeper layers or is complicated by infection. The ability to perform this acute care makes the optometrist the appropriate professional for the initial assessment and treatment of this injury.
Standard Treatment and Management
The primary goals in managing a corneal abrasion are to manage pain, prevent secondary bacterial infection, and promote rapid healing of the epithelial surface. Pain management often begins with a topical anesthetic drop during the examination for comfortable assessment. These drops are never dispensed for home use, however, due to their potential to delay healing and mask worsening symptoms. To address ongoing discomfort, oral non-steroidal anti-inflammatory drugs (NSAIDs) or prescription pain relievers may be recommended.
Preventing infection is accomplished by prescribing prophylactic antibiotic eye drops or ointments, which are the mainstays of treatment. For contact lens wearers, a broad-spectrum antibiotic from the fluoroquinolone class is often chosen due to the increased risk of infection from organisms like Pseudomonas aeruginosa. The antibiotic is typically dosed multiple times a day until the corneal surface is fully healed.
To accelerate healing and enhance comfort, patients are instructed to use lubricating drops or gels frequently. This provides a smooth surface for the eyelid to glide over instead of shearing the delicate healing tissue. In some cases, a therapeutic bandage contact lens may be placed on the eye to act as a physical barrier, reducing pain and assisting with epithelial cell migration. Follow-up examinations are mandatory, usually within 24 hours, to ensure the abrasion is healing as expected and to check for signs of developing complications, such as a corneal ulcer.
Indicators for Immediate Referral to an Ophthalmologist
While optometrists manage the majority of corneal abrasions, certain signs require immediate intervention from an ophthalmologist, a medical doctor and surgeon. A referral is necessary if the initial injury involved a high-velocity foreign body, raising suspicion of a full-thickness perforation or a metallic object embedded deep within the corneal tissue. An injury caused by a sharp object that created a laceration extending into deeper layers, such as the stroma or anterior chamber, also necessitates urgent surgical evaluation.
Specific clinical signs also trigger an immediate referral. These include the presence of an infectious corneal infiltrate—a white or gray opacity on the cornea—which suggests a developing ulcer requiring aggressive antibiotic treatment. Injuries caused by a chemical burn or severe thermal exposure also require the advanced medical and surgical expertise of an ophthalmologist due to the potential for widespread damage. Furthermore, any significant, progressive decline in vision, or the finding of blood (hyphema) or pus (hypopyon) in the anterior chamber, signals a severe internal injury. Finally, if a simple abrasion is not healing after three to four days of treatment, or if the patient experiences recurrent corneal erosion syndrome, specialist care is required.