Normal Cornea. A normal cornea that is transparent, avascular, and acts as a
barrier to infection.
Normal Cornea. A normal cornea that is transparent, avascular, and acts as a
barrier to infection.

What is Corneal Abrasion (Scratched Cornea)?

A corneal abrasion, also often known as a scratched cornea or scratched eye, is a frequent type of eye injury. It typically results in substantial discomfort, a feeling of something in the eye, intense pain, redness in the eye, sensitivity to light, and an abnormal fear of light. This condition occurs when cells in the cornea’s surface layer, known as the corneal epithelium, are disrupted or lost.

This kind of abrasion is usually caused by non-penetrating trauma to the corneal epithelium, accounting for a large portion of eye injuries seen in hospital emergency departments and by general practitioners.

Corneal abrasions can be categorized as resulting from trauma, foreign objects, fingernails, contact lenses, or can occur spontaneously. However, patients with simple superficial corneal abrasions usually recover fully within 3 to 5 days.

What Causes Corneal Abrasion (Scratched Cornea)?

Corneal abrasions, or scratches on the eye, most often happen because of minor injuries. Typical cases involve accidents like getting poked in the eye with a finger, fingernail, tree branch, paper, makeup brush, or getting sports equipment or workplace debris in the eye. Even materials like sand, foreign bodies, or other small particles can cause corneal abrasions, particularly if you rub your eyes.

Wearing contact lenses can also place you at a higher risk of getting a scratched cornea. This typically occurs when the lenses are damaged, misplaced, dried out, or worn for too long. Removing or tearing a dry, excessively worn contact lens can lead to abrasions. Wearing contact lenses for a long time or overnight might result in corneal abrasions and even eye infections. One such infection can be caused by a bacterium called Pseudomonas aeruginosa. If not identified and treated promptly, it could lead to severe keratitis (inflammation of the cornea) and other dangerous eye conditions.

Interestingly, corneal abrasions can also happen spontaneously and recur without any obvious injury. These are known as corneal erosions. They’re more common in people with certain eye and systemic conditions that cause dry eyes and those who’ve had a corneal abrasion before. These conditions often weaken the adhesive forces between the layers of the cornea. As a result, patients may experience sudden, sharp pain in one eye, especially upon waking up.

Risk Factors and Frequency for Corneal Abrasion (Scratched Cornea)

Corneal abrasions, or scratches on the surface of the eye, are common injuries across all age groups. They are especially common in workplaces, with US car manufacturing workers having 15 cases per 1,000 employees each year. Around 25% of these eye injuries occur on the job, with males aged 25 to 35 being the most affected. This might be due to this group often having unsafe jobs, less experience, and not using enough eye protection.

Risky factors for getting a corneal abrasion on the job include past eye injuries such as chemical burns or blunt trauma, jobs in building or production industry, not wearing adequate eye protection, and the use of contact lenses. In 2008, data showed that 60% of facial injuries requiring at least one day off work were due to eye injuries, which can be caused by objects stuck in the eye (34%), corneal abrasions (15%), and chemical burns (10%).

At primary care clinics, 2% of all visits are due to eye problems and 8% of those are because of foreign objects in the eye. In the US, accidents causing eye injuries such as objects in the eye and corneal abrasions have been shown to be quite common with 2 to 3 cases per 1,000 patients. In the UK, studies show that 64% of corneal abrasions were due to minor injuries.

It’s been found that about 45% of eye-related emergency room visits are due to corneal abrasions, and about a third are for foreign objects stuck in the eye. In patients complaining of a sensation of something stuck in their eye, 65% of cases had an object in their eye, while 13% had a corneal abrasion.

  • Contact lens use can often cause corneal abrasions.
  • About 140 million people worldwide use contact lenses for various reasons.
  • Corneal abrasions can happen due to not putting the lens in correctly, rubbing the eye, force to the eyelids, and objects stuck between the lens and the eye.
  • More than 10% of corneal abrasions seen in the emergency room are related to contact lens use.
  • Patients coming to the emergency room due to contact lens injuries often have corneal abrasions, staining of the eye surface, and small defects on the surface of the eye.
Corneal Lesion. Digital image of the patient depicting a fluorescein-stained
lesion.
Corneal Lesion. Digital image of the patient depicting a fluorescein-stained
lesion.

Signs and Symptoms of Corneal Abrasion (Scratched Cornea)

Corneal abrasions, or injuries to the eye’s surface, can cause various symptoms such as difficulty opening the eye, light sensitivity, a sensation of a foreign object in the eye, and eye pain. These injuries can occur in many ways, including from small pieces of wood or metal getting caught under the eyelid, especially in people who work with these materials. Signs of a corneal abrasion include redness, an unusual amount of tears, and decreased ability to see clearly. A tool called fluorescein staining is commonly used to assess corneal abrasions – the dye highlights the injury under special blue light.

Here are the identified symptoms, signs, causes, and preventative measures to consider for corneal abrasions:

  • Symptoms: Pain, foreign body sensation, excessive squinting, reflex tears, light sensitivity, redness in the eye, decreased visual acuity, history of trauma
  • Signs: Corneal defect, redness of the white part of the eye, corneal sub-edema, dilation of blood vessels around the cornea, smaller than normal pupil, blood in the eye due to severe trauma, pus in the eye due to an internal infection
  • Causes: Trauma, finger or nail scratch, makeup, tree branches or plants, small foreign bodies and debris, contact lenses, chemical or detergent splashes, aggressive eye rubbing, radiation burns, ingrown eyelashes
  • Prevention: Use of protective eyewear, avoiding excessive rubbing of the eye, thorough cleaning of the area around the eye, avoiding the use of contact lenses, proper use and cleaning of contact lenses, using artificial tears for dry eyes
Corneal Layers
Corneal Layers

Testing for Corneal Abrasion (Scratched Cornea)

If a patient is experiencing severe eye pain, a basic eye exam might start with a penlight. A not properly shaped pupil might indicate a severe issue, like a rupture. Using topical painkillers can make the examination process easier. It’s common to see redness or swelling, and there may be cloudiness if an ulcer or infection is present.

A hazy cornea can suggest swelling from excessive rubbing or damage to the cell layers of the cornea. The front compartment of the eye can be checked for blood pooling or pus. If either of these are spotted, the patient needs to be immediately referred to an eye specialist. Also, a reduction in vision clarity, especially notable ones, require a visit to an eye specialist. Unusual eye movements should also be recorded.

A special test using a dye called fluorescein can spot cornea injuries. An anesthetic drop is applied to the eye or on a fluorescein strip, which is then applied to the eye. This dye travels smoothly over a healthy cornea, but will stick to any damaged areas. When seen under a certain type of blue light, the dye will glow green if there’s any scraped-off cell layer. Trauma-related cornea injuries usually have linear or map-like patterns, whereas in contact lens wearers, multiple tiny injuries may merge to form a round, centralized defect. Herpes keratitis, an infection with a distinctive pattern, needs immediate treatment.

Foreign objects on the inner eyelid can cause vertical scratch-like injuries to the cornea; flipping the eyelids allows this part of the eye to be checked for any foreign objects.

Conjunctival Congestion. Digital image of the patient depicting 2
fluorescein-stained lesions in the conjunctiva along with conjunctival
congestion.
Conjunctival Congestion. Digital image of the patient depicting 2
fluorescein-stained lesions in the conjunctiva along with conjunctival
congestion.

Treatment Options for Corneal Abrasion (Scratched Cornea)

Applying topical antibiotics and eye relaxation medications are standard treatments for corneal abrasions. It used to be common practice to patch the eye while it was healing but this is now usually not recommended, especially in cases where the abrasion was caused by wearing contact lenses. Corneal abrasions are superficial, so there’s no need for a shot to prevent tetanus.

If there’s a foreign object in the cornea, the first steps usually involve trying to remove it with a cotton swab or by washing it out with saline solution. If these methods aren’t successful, a small medical instrument could be used for removal. Before attempting this, a medication that numbs the eye will be applied to reduce any discomfort. If it’s not possible to remove the object in these ways, a referral to an eye specialist will be needed. Following this, a course of topical antibiotics, often erythromycin, would be started.

There are several antibiotic options. Patients who have developed a corneal abrasion from wearing contact lenses need a specific type of antibiotic that fights off a common bacteria found in these cases. Those who don’t wear contact lenses might be prescribed an ointment containing erythromycin to be used four times a day over five days. Other options include eyedrops containing different antibiotics. After symptoms disappear and stay gone for 24 hours, the medication can usually be discontinued. But if symptoms persist for more than three days, an eye specialist’s opinion is needed. It’s recommended to avoid using corticosteroids as they can delay healing and raise infection risk.

Small abrasions usually aren’t very painful. Mild to moderate pain can typically be managed with over-the-counter anti-inflammatory medication. Special eye drops can also help with pain relief.

In rare cases, small abrasions that don’t seem to heal despite proper treatment might require stronger pain medications. Eye drops that relax the eyes can also be used to relieve light sensitivity. These treatments are usually effective within two days, but keep in mind that the eye-relaxing drops can cause temporary difficulty with reading.

If you’re experiencing sharp eye pain, blurry vision, sensitivity to light, red eyes, or the feeling of something in your eye, these could be symptoms of a number of different eye conditions. You may need urgent eye care, and the doctor will consider several possibilities when figuring out what is wrong. These could include:

  • Keratoconjunctivitis (inflammation of the cornea and conjunctiva)
  • Dry eye syndrome
  • An urgent form of glaucoma
  • Uveitis (inflammation inside the eye)
  • Infections of the cornea caused by bacteria, fungus, or herpes
  • Corneal ulcer (an open sore on the cornea)
  • Regular corneal erosions
  • Eye injury or trauma
  • Damage to the cornea due to lack of nerve sensation
  • Issues following eye surgery
  • A deficiency of limbal stem cells (cells that help to regenerate the cornea)
  • Trichiasis (where eyelashes grow inwards)
  • Damage to the cornea caused by UV light or harmful substances

The doctor will use appropriate examinations and tests to figure out the cause of these symptoms so they can provide the best treatment.

What to expect with Corneal Abrasion (Scratched Cornea)

Generally, if corneal abrasions (scratches on the eye’s surface) receive prompt treatment, the outlook is typically excellent. However, if left untreated, these abrasions could lead to severe infection and permanent scarring, possibly resulting in blindness.

Minor corneal abrasions usually heal easily within less than 5 days. However, larger abrasions, those that affect your vision, or those caused by a contact lens would need careful monitoring by an eye doctor. Deep abrasions located in the central vision area may heal but also leave a scar. In these situations, it might result in a permanent reduction of clear vision due to the cornea becoming cloudy or irregularly shaped.

There is also a risk of what’s known as ‘recurrent corneal erosions’ for those with a history of corneal abrasions. These recurrent erosions are particularly common if there are other existing eye conditions (such as epithelium basement membrane dystrophy, lattice degeneration, band keratopathy), prior eye surgery (for example, for correcting vision, cataract, or retina), or dry eye disease.

Possible Complications When Diagnosed with Corneal Abrasion (Scratched Cornea)

Minor corneal abrasions, which are small scratches on the clear surface of the eye, usually recover without too much trouble. However, more serious abrasions can lead to a set of complications. These include:

  • Corneal ulcers: deep sores on the cornea
  • Bacterial keratitis: bacterial infection in the cornea
  • Recurrent erosion syndrome: frequent return of cornea damage
  • Corneal stromal scarring: scarring in the deeper layers of the cornea
  • Traumatic iritis: inflammation caused by eye injury

Preventing Corneal Abrasion (Scratched Cornea)

If you work in a high-risk job, play contact sports, or do activities that could scratch your eye or expose it to strong sunlight, it’s really important you wear safety glasses. People who use contact lenses should make sure they fit properly and replace them when they’re meant to. If something foreign gets in your eye, avoid rubbing it, as this could further harm your cornea. If you have suffered a severe cornea scratch, be sure to follow up with an eye doctor.

Frequently asked questions

A corneal abrasion, also known as a scratched cornea or scratched eye, is a common type of eye injury. It occurs when cells in the cornea's surface layer, called the corneal epithelium, are disrupted or lost. Symptoms include discomfort, pain, redness, sensitivity to light, and an abnormal fear of light.

Corneal abrasions are common, with about 45% of eye-related emergency room visits being due to corneal abrasions.

The signs and symptoms of Corneal Abrasion (Scratched Cornea) include: - Pain - Foreign body sensation - Excessive squinting - Reflex tears - Light sensitivity - Redness in the eye - Decreased visual acuity - History of trauma In addition to these symptoms, there are also specific signs that can indicate a corneal abrasion: - Corneal defect - Redness of the white part of the eye - Corneal sub-edema - Dilation of blood vessels around the cornea - Smaller than normal pupil - Blood in the eye due to severe trauma - Pus in the eye due to an internal infection These signs and symptoms can help in identifying and diagnosing a corneal abrasion. It is important to seek medical attention if you experience any of these symptoms or signs, as prompt treatment can help prevent complications and promote healing.

Corneal abrasions, or scratched corneas, can occur due to various causes such as trauma, finger or nail scratches, makeup, tree branches or plants, small foreign bodies and debris, contact lenses, chemical or detergent splashes, aggressive eye rubbing, radiation burns, and ingrown eyelashes.

The doctor needs to rule out the following conditions when diagnosing Corneal Abrasion (Scratched Cornea): - Keratoconjunctivitis (inflammation of the cornea and conjunctiva) - Dry eye syndrome - An urgent form of glaucoma - Uveitis (inflammation inside the eye) - Infections of the cornea caused by bacteria, fungus, or herpes - Corneal ulcer (an open sore on the cornea) - Regular corneal erosions - Eye injury or trauma - Damage to the cornea due to lack of nerve sensation - Issues following eye surgery - A deficiency of limbal stem cells (cells that help to regenerate the cornea) - Trichiasis (where eyelashes grow inwards) - Damage to the cornea caused by UV light or harmful substances

The types of tests that are needed for Corneal Abrasion (Scratched Cornea) include: - Basic eye exam with a penlight to check for pupil shape and any severe issues like a rupture - Topical painkillers to make the examination process easier - Examination for redness, swelling, cloudiness, and hazy cornea - Checking the front compartment of the eye for blood pooling or pus - Special test using a dye called fluorescein to spot cornea injuries - Checking for foreign objects on the inner eyelid - Applying topical antibiotics and eye relaxation medications as standard treatments - Trying to remove foreign objects with a cotton swab or saline solution - Referral to an eye specialist if removal is not possible - Prescribing specific antibiotics based on the cause of the corneal abrasion - Managing pain with over-the-counter anti-inflammatory medication and special eye drops - Stronger pain medications and eye drops for light sensitivity in rare cases of non-healing abrasions.

Corneal abrasions (scratched corneas) are typically treated with topical antibiotics and eye relaxation medications. Patching the eye is no longer recommended, especially if the abrasion was caused by wearing contact lenses. If there is a foreign object in the cornea, attempts will be made to remove it with a cotton swab or saline solution. If these methods are unsuccessful, a small medical instrument may be used. A medication that numbs the eye will be applied before attempting removal to reduce discomfort. Referral to an eye specialist may be necessary if the object cannot be removed. Antibiotics, such as erythromycin, are often prescribed. Over-the-counter anti-inflammatory medication and special eye drops can help manage pain. In rare cases, stronger pain medications may be needed, and eye drops that relax the eyes can be used to relieve light sensitivity.

The side effects when treating Corneal Abrasion (Scratched Cornea) can include temporary difficulty with reading due to eye-relaxing drops, as well as potential complications such as corneal ulcers, bacterial keratitis, recurrent erosion syndrome, corneal stromal scarring, and traumatic iritis.

The prognosis for corneal abrasion (scratched cornea) is typically excellent if prompt treatment is received. Minor abrasions usually heal easily within less than 5 days. However, larger abrasions, those that affect vision, or those caused by a contact lens may require careful monitoring by an eye doctor. Deep abrasions in the central vision area may heal but can leave a scar, potentially resulting in a permanent reduction of clear vision. There is also a risk of recurrent corneal erosions for those with a history of corneal abrasions.

An eye specialist or optometrist.

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