Chapter 17: Corneal Foreign Body and Corneal Abrasion

PATIENT STORY

A 28-year-old man felt something fly into his eye while he was using a table saw without wearing protective eye gear. He presented with pain, tearing, photophobia, and thought that something was still in his eye. On examination with a slit lamp, the physician noted that he had a wood chip that had penetrated the cornea (Figures 17-1 and 17-2). He was referred to an ophthalmologist who successfully removed the foreign body. He was treated with a short course of topical nonsteroidal anti-inflammatory drugs (NSAIDs) for pain relief and had complete healing.

INTRODUCTION

Corneal abrasions are often caused by eye trauma, retained foreign bodies, chemical splash, or improper contact lens use. Such abrasions can cause an inflammatory response. Eyes that have had prior corneal abrasions or eyes that have an underlying corneal epithelial abnormality may experience spontaneous defects that are referred to as recurrent erosions.¹ Corneal abrasions are detected using fluorescein and a UV light. A corneal foreign body can be seen during a careful physical examination with a good light source or slit lamp. Nonpenetrating foreign bodies can be removed by an experienced physician in the office using topical anesthesia. Refer all penetrating foreign bodies to an ophthalmologist.

SYNONYMS

Corneal abrasion is sometimes referred to as a corneal epithelial defect, a broader term that refers to all corneal defects, whether traumatic, spontaneous, acquired, or genetic.

EPIDEMIOLOGY

• Corneal abrasions with or without foreign bodies are common; however, the prevalence or incidence of corneal abrasions in the general population is unknown.

• Corneal abrasions accounted for 85% of closed-eye injuries in adults presenting to an emergency department.²

• In professional sports, such as major league baseball, 33% of all eye injuries are corneal abrasions. In professional basketball, corneal abrasions account for 12% of eye injuries, while 1 in 10 college basketball players sustains an eye injury, usually corneal abrasion, each year.^3,4

• Incidence of corneal abrasion for patients undergoing general anesthesia is as high as 44% due to surface trauma from surgical drapes, anesthetic masks, or exposure.⁴

ETIOLOGY AND PATHOPHYSIOLOGY

• The cornea overlies the iris and provides barrier protection, filters UV light, and refracts light onto the retina.

• Abrasions in the cornea can be caused by:

  • Direct injury from a foreign body

  • Extended contact lens wear

  • Eye makeup applications

  • Thermal/chemical burns (e.g., ear ...