Most superficial abrasions heal within a short period, but the eye should be examined to rule out a foreign body, infection, or deeper injury. Treatment differs from one patient to another, and eye drops or ointments should not be used without medical assessment.
Definition & Symptoms
What is an abrasion and what does it feel like?Treatment
Patching or no patchingFollow-up
When is daily review needed?Complications
Infection, scarring and recurrenceRecurrent Corneal Erosion
Symptoms and available treatment optionsUrgent Situations
When should I seek immediate medical review?What Is a Corneal Abrasion?
The cornea is the transparent front part of the eye. A corneal abrasion occurs when the thin outer layer covering its surface is damaged. Although the injury may be superficial, it can cause considerable pain because the cornea is highly sensitive.
Common Symptoms
- Eye pain or burning.
- A gritty or foreign-body sensation.
- Increased tearing and redness.
- Light sensitivity and difficulty opening the eye.
- Blurred vision, especially when the abrasion involves the central cornea.
What Causes a Corneal Abrasion?
- Finger or fingernail injury: One of the most common causes; it may occur accidentally, during play, or from a child’s fingernail.
- Contact lenses: Incorrect use, sleeping in lenses, prolonged wear, or forceful removal can injure the corneal surface.
- Forceful eye rubbing: Especially when itching, dust, or a foreign body is present.
- Dust, sand, or debris: This may happen during windy conditions or outdoor activities.
- Work-related injuries: Such as metal fragments, wood particles, or flying debris when protective eyewear is not used.
- Tree branches and plant material: These injuries may require special attention because of contamination risk.
- Sports injuries or direct trauma: Especially in contact sports or sports involving fast-moving balls.
- Foreign bodies and attempts to remove them: The foreign body itself or attempts to remove it may cause additional corneal injury.
How Is a Corneal Abrasion Diagnosed?
- Visual acuity testing and slit-lamp examination.
- Fluorescein dye is used to show the location and size of the abrasion.
- The eyelid is examined to make sure no foreign body is trapped underneath.
- The doctor checks for corneal infection, penetrating injury, or deeper damage.
How Is a Corneal Abrasion Treated?
Treatment May Follow One of Two Approaches
The ophthalmologist decides whether the eye should be patched or treated without a patch. The decision is based on the overall clinical assessment, not abrasion size alone.
Treatment with Eye Patching
The doctor may choose eye patching in selected cases after examination confirms that this approach is appropriate and safe.
- Apply a preventive antibiotic ointment rather than a drop: Ointment may be selected because it remains on the ocular surface longer than a drop, helping maintain coverage while the eye is patched.
- Use a pupil-dilating drop when appropriate: It may be used to reduce pain from ciliary spasm and can temporarily cause blurred vision and light sensitivity.
- Patch the eye: The patch is applied after the prescribed ointment and drop according to the doctor’s instructions.
- Daily review: At each review, the doctor removes the patch and examines the cornea to assess healing and check for signs of infection.
- Repeat treatment if healing is incomplete: If the abrasion has not fully healed, treatment may be repeated and the eye re-patched, with another review arranged.
Treatment Without Eye Patching
With this approach, the eye remains uncovered and treatment is selected according to abrasion severity, pain, and cause.
- Frequent ocular lubrication: Lubricating drops are used frequently to reduce friction and soothe the corneal surface.
- Add lubricating ointment or gel when needed: It can be used with lubricating drops to remain on the eye longer, particularly during sleep.
- Pupil-dilating drop if pain is significant: The doctor may prescribe it to help reduce pain depending on the clinical situation.
- Preventive antibiotic drops: These may be used to reduce the risk of bacterial infection, with the medication and duration selected according to the injury and risk factors.
- Bandage contact lens in selected cases: A special therapeutic lens may be placed to reduce pain, protect the corneal surface, and support healing while treatment and medical follow-up continue.
- Remove the lens after complete healing: The therapeutic lens is removed by the doctor after confirming complete healing.
Do not use topical anesthetic drops at home, patch the eye yourself, or place an ordinary contact lens over an abrasion. Contact-lens injuries, contaminated injuries, and cases with suspected infection require a different treatment plan and close ophthalmic follow-up.
Follow-up and Healing Time
Many small abrasions heal within one or two days, while larger abrasions may take several days. Healing speed depends on size, location, cause, and the condition of the ocular surface.
- When eye patching is used, follow-up is often daily until healing is complete.
- When a bandage contact lens is used, follow-up appointments must be kept and the lens should not be removed by the patient.
- Ordinary contact lenses should not be resumed until the doctor confirms complete corneal healing.
- Seek earlier review if pain does not improve or symptoms worsen.
What Are the Complications of a Corneal Abrasion?
- Bacterial keratitis: Risk is higher in contact-lens users and contaminated injuries.
- Corneal ulcer: A deeper injury requiring urgent treatment to reduce the risk of visual damage.
- Corneal scarring: May occur after a deep abrasion or significant infection and can affect vision when centrally located.
- Recurrent corneal erosion: Some patients develop sudden pain on waking because the superficial layer remains poorly adherent after the previous injury.
- Delayed or incomplete healing: This may require additional treatment and longer follow-up.
Recurrent Corneal Erosion
What Is Recurrent Corneal Erosion?
After a corneal abrasion heals, the outer corneal layer may not adhere strongly to the underlying layers. It can then separate again, a condition known as recurrent corneal erosion.
Pain often occurs on waking or when opening the eye because the eyelid can stick to the corneal surface during sleep and pull away part of the superficial layer.
Possible Symptoms
- Sudden eye pain, especially on waking.
- A foreign-body or gritty sensation.
- Increased tearing and redness.
- Light sensitivity and difficulty opening the eye.
- Temporary blurred vision.
How Is Recurrent Corneal Erosion Treated?
Treatment depends on the cause, recurrence frequency, location of the erosion, symptom severity, and response to previous therapy. Not every patient needs every option; treatment is usually escalated step by step.
- Lubricating drops and ointments for at least 6 months: Lubricating drops are used regularly during the day with ointment or gel before sleep to reduce eyelid friction and give the epithelium a better chance to adhere.
- Hypertonic saline drops or ointment for at least 6 months: The doctor may prescribe hypertonic saline preparations to reduce fluid accumulation within the superficial layer and improve epithelial adhesion.
- Corticosteroid drops in selected cases: They may be used under ophthalmic supervision in selected treatment plans and should not be used without prescription and monitoring.
- Extended use of a bandage contact lens: A therapeutic lens may be worn for several weeks or for the duration determined by the doctor to protect the corneal surface, reduce pain, and allow epithelial adhesion. Preventive antibiotic drops and regular follow-up are typically added.
- Anterior Stromal Puncture: The doctor creates tiny punctures in the anterior cornea to stimulate epithelial adhesion. This is used in selected cases, usually when the erosion is away from the visual axis.
- Alcohol-assisted epithelial removal: In selected cases, poorly adherent epithelium is removed using dilute alcohol, followed by placement of a bandage contact lens, preventive antibiotic drops, and follow-up until healing is complete.
- Phototherapeutic Keratectomy (PTK): Laser treatment is used to improve corneal surface regularity and encourage epithelial adhesion. It is performed in selected cases after appropriate corneal assessment.
- Vision-correction laser in selected patients: Laser vision correction may be considered in selected patients to correct refractive error while also helping reduce recurrent erosions. It is not suitable for every case and requires specific testing and eligibility criteria.
When Should I Seek Urgent Ophthalmic Review?
- Reduced vision or increasing blur.
- Increasing pain or redness instead of improvement.
- Discharge or a white spot on the cornea.
- Injury while wearing contact lenses.
- Injury from a high-speed metal object, chemical, or plant branch.
- Severe difficulty opening the eye or persistent marked light sensitivity.
- No improvement within 24 to 48 hours.
Have You Had an Eye Injury or Scratch?
Early eye examination is recommended to determine abrasion depth, rule out a foreign body or corneal infection, and select the appropriate treatment plan.