Corneal Injuries

Author: Carl McQueen / Editor: Yasmin Sultan / Reviewer: Shanthi Siva, Raja Shahid Ali / Code: O8 / Published: 05/01/2022

Prerequisites

Before commencing this session you should:

• Have a good knowledge of eye anatomy

Description:

This session will cover the assessment and management of corneal injuries.

After completing this session you will be able to:

• Describe the relevant corneal anatomy and outline the pathophysiology of corneal abrasions, foreign bodies and burns
• Identify a corneal abrasion and formulate an appropriate treatment plan
• Identify a corneal foreign body and rust ring and describe methods for their removal
• Recognise an ultraviolet corneal burn and chemical splash to the eye and formulate appropriate treatment strategies for these conditions.

References

1. Bhopal RS, Parkin DW, Gillie RF, et al. Pattern of ophthalmological accidents and emergencies presenting to hospitals. J Epidemiol Community Health 1993;47:382-387.
2. Thompson GJ, Mollan SP. Occupational eye injuries: a continuing problem. Occup Med (Lond) 2009;59:123-125. View abstract
3. May DR, Kuhn FP, Morris RE, et al. The epidemiology of serious eye injuries from the United States Eye Injury Registry. In: Graefe’s Archive for Clinical and Experimental Ophthalmology. Berlin: Springer 2000;238:153-157.
4. Guly CM, Guly HR, Bouamra O, et al. Ocular injuries in patients with major trauma. Emerg Med J 2006;23:915-917.
5. Dua HS, Forrester JV. Clinical patterns of corneal epithelial wound healing. Am J Ophthalmol 1987;104:481-489.
6. Le Sage N, Verreault R, Rochette L. Efficacy of eye patching for traumatic corneal abrasions: a controlled clinical trial. Ann Emerg Med 2001;38:129-134.
7. Jones G. Foreign bodies in the eye. Accid Emerg Nurs 1998;6:66-69.
8. Zuckerman BD, Lieberman TW. Corneal rust ring. Arch Ophthalmol 1960;63:254-265.
9. Bashour M. Corneal foreign body [Internet]. eMedicine 2008. View article
10. Nagendran T. Management of foreign bodies in the emergency department. Hosp Physician 1999;35:27-40.
11. eMedicine Health [Internet]. Chemical eye burns. View link
12. Renard G. Physiopathology of eye burns. J Fr Ophtalmol 2004;27:1164-1169.
13. Borderie V. Clinical aspects of corneal burns. J Fr Ophtalmol 2004;27:1170-1174.
14. Steffen J, Batrick N. Proxymetacaine is the local anaesthetic of choice for removal of corneal foreign bodies [Internet]. BestBETs: best evidence topics. 2005. View article
15. Flynn CA, D’Amico F, Smith G. Should we patch corneal abrasions? A meta-analysis. J Fam Pract 1998;47:264-270.
16. Michael JG, Hug D, Dowd MD. Management of corneal abrasion in children: a randomized clinical trial. Ann Emerg Med 2002;40:67-72.
17. Arbour JD, Brunette I, Boisjoly HM, et al. Should we patch corneal erosions? Arch Ophthalmol 1997;115:313-317.
18. Campanile TM, St Clair DA, Benaim M. The evaluation of eye patching in the treatment of traumatic corneal epithelial defects. J Emerg Med 1997;15:769-774.
19. Kaiser PK. A comparison of pressure patching versus no patching for corneal abrasions due to trauma or foreign body removal. Corneal Abrasion Patching Study Group. Ophthalmology 1995;102:1936-1942.
20. Turner A, Rabiu M. Patching for corneal abrasion. Cochrane Database Syst Rev 2006;2:CD004764.
21. Carley F, Carley S. Towards evidence based emergency medicine: best BETs from the Manchester Royal Infirmary. Mydriatics in corneal abrasion. Emerg Med J 2001;18:273.
22. Shields SR. Managing eye disease in primary care. Part 3. When to refer for ophthalmologic care. Postgrad Med 2000;108,99-106.
23. Wilson SA, Last A. Management of corneal abrasions. Am Fam Physician 2004;70:123-128.
24. Ziaei M. Lubricants should not be used in corneal abrasions [Internet]. BestBETs: best evidence topics. 2005. View article
25. Weaver CS, Terrell KM. Evidence-based emergency medicine. Update: do ophthalmic nonsteroidal anti-inflammatory drugs reduce the pain associated with simple corneal abrasion without delaying healing? Ann Emerg Med 2003;41:134-140.
26. Mehta D, ed. British National Formulary. 54th edn. London: BMJ Publishing Group, 2007.
27. Calder LA, Balasubramanian S, Fergusson D. Topical nonsteroidal anti-inflammatory drugs for corneal abrasions: meta-analysis of randomized trials. Acad Emerg Med 2005; 12:467-473.
28. Benson WH, Snyder IS, Granus V et al. Tetanus prophylaxis following ocular injuries. J Emerg Med 1993;11:677-683.
29. Upadhyay MP, Karmacharya PC, Koirala S et al. The Bhaktapur eye study: ocular trauma and antibiotic prophylaxis for the prevention of corneal ulceration in Nepal. Br J Ophthalmol 2001;85:388-392.
30. Boberg-Ans G, Nissen KR. Comparison of fucithalmic viscous eye drops and chloramphenicol eye ointment as a single treatment in corneal abrasion. Acta Ophthalmol Scand 1998;76:108-111.
31. Khaw PT, Shah P, Elkington AR. Injury to the eye. BMJ 2004;328:36-38.
32. Weissman BA. Care of the Contact Lens Patient: Reference Guide for Clinicians. St. Louis: American Optometric Association, 2000.
33. Aslam SA, Sheth HG, Vaughan AJ. Emergency management of corneal injuries. Injury 2007;38:594-597.
34. Sigurdsson H, Hanna I, Lockwood AJ et al. Removal of rust rings, comparing electric drill and hypodermic needle. Eye 1987;1:430-432.
35. National Poisons Information Service (NPIS). TOXBASE [Internet]. Chemicals splashed or sprayed into the eyes. 2007. View link
36. Kuckelkorn R, Schrage N, Keller G et al. Emergency treatment of chemical and thermal eye burns. Acta Ophthalmol Scand 2002;80:4-10.
37. Kuckelkorn R, Kottek A, Schrage N et al. Poor prognosis of severe chemical and thermal eye burns: the need for adequate emergency care and primary prevention. Int Arch Occup Environ Health 1995;67:281-284.
38. Blais BR. Treating chemical eye injuries. Occup Health Saf 1996;65:23-26.
39. Peate WF. Work-related eye injuries and illnesses. Am Fam Physician 2007;75:1017-1022.
40. Svinos H, O’Malley A. Blown air is the best treatment for eye irritation caused by CS spray [Internet]. BestBETs: best evidence topics. 2008. View article.
41. Jacobs DS, Corneal abrasions and corneal foreign bodies: Management. UpToDate. 2021.