Corneal Scratches

A friend called me this morning to ask for some advice on where to take his son for a scratched cornea- an optometrist or an ophthalmologist.  He mentioned the fact that he thought his son might need a protective contact lens for a few days while the abrasion healed.  Another relative of his had received this treatment for an eye abrasion some time past.  I have had many corneal abrasions over the years, usually as a result of getting dirt under my contact and I have always either waited it out (it usually clears up after a day or two) or go to my eye doctor who gives me antibiotic drops and tells me to leave my contacts out for a few days.  Once, many years ago, I actually had corneal ulcers as a result of ill-fitting hard contact lenses back in the days when they were popular. For that, I was referred to an eye hospital and received a series of antibiotic and steroid treatments that were very slow in healing the lesions.  In fact, I read the literature on healing in corneal injuries and took things into my own hands at the time, with a good swim in chlorinated water to ‘re-injure’ my eyes, therefore stimulating a faster healing response.  Looking back this was highly risky and not to be recommended.

Since my friend has called me today, I was prompted to look up the latest on corneal abrasions and pass on what I find to readers.

What is the cornea anyway?
The cornea is the transparent covering over the colored part of your eye as well as the dark spot in the middle that is the pupil.  The cornea is very sensitive as there are many nerve endings just beneath its surface. The cornea normally has no blood vessels and gets the oxygen it needs to say healthy directly from the oxygen in the air.  The cornea bends the light that enters the eye to help focus images on the retina at the back of the inside of the eye.  For people who are near-sighted, Lasik or other laser techniques are used to reshape the cornea, changing the way it bends light thus helping to improve the ability of the eye to focus appropriately.

So, what is a corneal scratch?
The cornea is very sensitive to touch, temperature or chemicals and the eye involuntarily closes when the cornea is touched.   Often we will blink before an object actually touches our eye but when we don’t blink in time, a corneal scratch can occur, which you may hear referred to as a corneal abrasion by doctors.  These scrapes are very painful due to all those nerve endings and often cause significant watering of the eyes as well as redness in the white areas around the cornea.  The scrape to the eye may damage deeper layers of tissue, and is also at risk of infection so medical attention is necessary if you think you have scratched the surface of your eye.  Common causes of corneal abrasions are getting poked in the eye, wearing contact lenses too long (because you are depriving your eyes of oxygen), some types of infections, being hit in the eye by cigarette ash or other flying particle, or even from ultraviolet light such as sun lamps.

How will I know if I have scratched my cornea?
It will probably hurt!  It could also be red and watery but this is not always the case. Personally, I had corneal ulcers which are much more severe that an abrasion, and I did not feel a thing until one day when I felt as if I had something in my eye and I thought my contact lens was scratched!  I had been wearing contact lenses for several years and my eyes were probably de-sensitized.  I had not felt the ulcers in their early stages when the cornea had just mild abrasions. 

Symptoms you should look out for are:

• Feeling like you have something in your eye that you can’t get rid of
• Watering of your eyes that doesn’t stop
• Blurred or distorted vision
• Pain in your eye, especially when you look at the light
• Colored halos around lights at night
• •    Inability to open your eye properly or squinting badly

What should I do if I think I have a corneal abrasion?
If you have any or all of the above symptoms and you think you have hurt your cornea in some way you should get your eye checked at an ophthalmologist. An ophthalmologist is a medical doctor specializing in eye problems.  If it is after hours, then a trip to the emergency room is warranted

What happens at the doctor?
The doctor will ask you how you think you injured your eye and will look at the cornea in a couple of ways.  First he will numb your eye with drops so that you he can open it properly and take a look at the cornea with a normal light.  If you are taking any medications you must tell your doctor just in case the drops might interfere with the medicine or make any other conditions you have worse.  This is especially important if you are taking other eye medications.  The doctor may put additional yellow drops in and then look closely at your cornea with a UV lamp to show up the abrasions.  From these tests the doctor will determine if you do have a scratch and how to treat it.  Treatments can include antibiotic lotions or drops to prevent infection, steroid drops to reduce inflammation and help healing, or drops to reduce any spasms in your eyes.  Eye patches are sometimes used but recent studies have shown they may inhibit the healing process.  Your ophthalmologist will decide what is best for you based on the extent of the damage to your cornea and the rest of your health.  For more severe abrasions, cold compresses may be used and even ‘bandage contact lenses’ to protect the eye while it begins to heal.
You will not be given numbing drops to use at home as they do not help the healing process so you might have to take some regular pain pills when you get home.

Is that it?
You might be asked to come back after a couple of days to check on your progress.  If the abrasion was severe then you may have to have follow-up exams to see how the healing process is going.  If your eye does not seem to get better, or your vision changes in some way, then it would be important to go back to see the doctor.  Most abrasions heal in 1-2 days.  If you wear contact lenses, then the doctor will probably tell you to leave them out for a few days.

Will my eye recover completely?

Corneal abrasions are the most common type of eye injury and often don’t even make it to the doctors office because they heal so quickly. If the injury is mild, you should have no lasting scars. If the injury is deeper, then you may have a scar on your cornea.  Your doctor will be able to tell you what to expect.

Avoiding injury in the future
Some injuries are difficult to predict and therefore avoid such as a poke in the eye.  However, corneal abrasions due to contact lenses can be minimized by not wearing lenses too long, especially over-night. Wearing appropriate eye protection when doing sports or at work in high-risk environments is very important in protecting against corneal injury.  Always washing hand before touching the eyes can prevent infection related abrasions.