Corneal Injuries

Corneal Injury and Foreign Bodies

Minor scratches or abrasions to the cornea are common. They can be extremely sore but usually heal in 24-48 hours. A course of antibiotic eye drops or ointment is commonly prescribed to prevent an eye infection from developing. More serious injuries to the eye may occur from sharp objects and from small flying particles hitting the eye at high speed. Serious injury can also result from chemical burns. Always see a doctor for a proper eye examination if you suspect that your eye has been injured from a small flying particle, or from a chemical.

What causes corneal injury?

·         Corneal scratches/abrasions

·         Small flying objects

·         CS gas and pepper spray

·         Radiation damage

·         Chemical injuries

Examination of the eye

If you suspect you have a corneal injury, it is best to see a doctor. If you suspect an injury from a flying small particle or from a chemical you should see someone quickly, which may mean attending accident and emergency. A doctor may use a magnifying instrument to examine your eye. A drop of a special dye (fluorescein) is commonly put on the front of the eye if a corneal injury is suspected. This shows up scratches that might otherwise not be seen. The eye examination also checks for serious damage.

What is the treatment for a corneal injury?

Treatment for a chemical burn to the eye

All chemical eye injuries should be treated very seriously as they can damage your vision severely. Treat with immediate first aid by irrigating the eye massively with clean water:

• Remove contact lenses if present.
• Immediately wash out the eye with lots and lots of water for at least 10-15 minutes:
• The best way of doing this is beneath a running tap. After testing the water temperature, position your eye beneath a running cold tap or hose.
• Hold your eyelids open with your fingers and allow the water to run over your eye.
• If both eyes are involved and there is only one source of water try to keep alternating the eyes. Lying on your back in the bath may be easier than positioning your head in a sink. 
• Alkalis are particularly damaging and any loose bits of material such as lime or plaster must be completely washed out, or they will continue to damage the eye. You can lift your upper eyelids away from the eyeball by the lashes to do this, allowing the water to wash in, and pull the lower lids gently down and outwards.
• You need to check that no bits are left behind the eyelids (the eyelids will feel gritty if there are particles trapped there, although this feeling may persist even after the bits are gone). 
• Then go to your nearest accident and emergency department as soon as possible. You should be assessed urgently by an eye specialist.

Treatment for CS gas and pepper spray

CS gas is ideally treated by evaporating the substance off the eyes using a hair dryer on a cool setting. Clothes should be removed and ventilated; you should ideally have a lukewarm shower. Pepper spray should be washed out immediately with copious liquid, as if it were a chemical injury.

Treatment for scratches/abrasions/flying objects/radiation injury

A small corneal scratch or abrasion usually heals over a couple of days or so.

Eye infection is a complication that may follow an injury or scratch to the cornea. Therefore, it is routine to prescribe antibiotic eye drops or ointment for up to a week to prevent infection. Chloramphenicol or fusidic acid are most commonly used, although if you have scratched your eye with a contact lens you may be prescribed gentamicin eye drops. Painkillers such as paracetamol or ibuprofen will ease pain.

Sometimes a small particle becomes slightly embedded in the cornea. This needs to be removed, as it may lead to infection or staining. It is often possible for a doctor to remove it using a cotton wool bud. Sometimes a fine needle may be needed to lift it out. Local anaesthetic eye drops are used if this is done, to make the procedure painless. The surface of the eye is actually surprisingly hard so don't worry. The doctor will not harm your eye with the needle. A particle of metal on the eye is removed in the same way. However, if it has started to produce a ring of rust this is removed using a specially burring tool, to make sure that all the rust spots are removed.

• Radiation injury to the eye is treated as for corneal abrasions. Some of the pain in arc eye results from spasm of the iris muscle. A drop of cyclopentolate, which relaxes the pupil's muscles, may ease this. It will, however, make your vision slightly blurred.
• Local anaesthetic drops are used in the eye immediately to manage the corneal injury. However, although it seems tempting to keep using these drops in order to keep the eye comfortable, in fact using local anaesthetic repeatedly in the eye delays healing. Therefore, this is not a recommended treatment.
• If you normally wear contact lenses, do not wear them while the cornea is healing or whilst using antibiotic eye drops. You also should not wear them for 24 hours after the final dose of antibiotic eye drops, as they can become discoloured.
• An eye patch to cover the eye is not normally advised following a corneal scratch or abrasion (as was commonly advised in the past). This is because studies have shown that using a patch does not improve healing rates and does not reduce pain. Removal of the patch tends to result in the healing tissue on the cornea stripping off again as you blink, so you are back to the start of healing again. In addition, if you wear an eye patch you lose your depth vision using two eyes (your binocular vision). The exception is if local anaesthetic eye drops have been used for assessment or treatment and the eye is numb. A patch may then be advised for a few hours until the sensation returns to the eye, in order to protect it. This is needed because an eye with anaesthetic drops in it may not blink if something flies into it.
• You will be referred to an eye specialist if you have a deep or penetrating injury to the eye or if there are any concerns that the eye is more seriously damaged. Specialised assessment and treatment may be needed.
• Note: do not drive unless you have normal vision in both eyes and the effects of eye drops (if used) have worn off.

How to prevent corneal injuries

Always wear eye protection when you drill, saw, etc - activities which cause flying small particles. Wear specialised ultraviolet protection when welding, skiing, mountaineering, using sunbeds and in any other situation where there is a lot of light radiation. Take particular care when using hazardous chemicals such as acid or alkali, washing your hands regularly and protecting the eyes if there is any risk of material splashing or exploding. Wear protective goggles when dealing with cement and plaster dust.

A leaflet on protecting the eyes is available from the Canadian Ophthalmological Society (see Further reading below).

Follow-up

Depending on the severity of the injury, your doctor may advise that you should be reviewed in 24-48 hours after the injury. This is to see if healing is underway. However, see a doctor as soon as you can if your vision becomes worse, if you have worsening pain (beyond that due to the local anaesthetic wearing off) or if your corneal abrasion does not seem to have healed after 72 hours.

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