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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 15-1 and 15-2). He was referred to an ophthalmologist who successfully removed the foreign body. He was treated with a short course of topical NSAIDs for pain relief, and had complete healing.
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Corneal abrasions are often caused by eye trauma and can cause an inflammatory response. 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.
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Corneal abrasion is sometimes referred to as a corneal epithelial defect.
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- 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.1
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- The cornea overlies the iris and provides barrier protection, filters UV light, and refracts light onto the retina.
- Abrasions in the cornea are typically caused by direct injury from a foreign body, resulting in an inflammatory reaction.
- The inflammatory reaction causes the symptoms and can persist for several days after the foreign object is out.
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- Those with occupations such as metal workers, woodworkers, miners, and landscapers have an increased risk of corneal injuries from foreign bodies.2
- Participating in sports such as hockey, lacrosse, or racquetball raises the risk of corneal abrasions from ocular trauma.2
- Ventilated neonates (as a result of mask pressure on the orbit) or sedated patients (as a result of disruption of the blink reflex, and subsequent corneal exposure) are at increased risk for corneal abrasions.2
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Contact lenses, especially soft extended wear, increase the risk of developing an infected abrasion that ulcerates.2
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- History of ocular trauma or eye rubbing (although corneal abrasions can occur with no trauma history).
- Symptoms of pain, eye redness, photophobia, and a foreign-body sensation.
- Foreign body seen with direct visualization or a slit lamp (Figure 15-3...