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Corneal injury

Definition

Corneal injury describes an injury to the cornea. The cornea is the crystal clear (transparent) tissue covering the front of the eye. It works with the lens of the eye to focus images on the retina.

See also: Corneal ulcers and infections

Causes, incidence, and risk factors

Injuries to the cornea are common.

Injuries to the outer surface of the cornea, called corneal abrasions, may be caused by:

• Chemical irritation - from almost any fluid that gets into the eye
• Overuse of contact lenses or lenses that don't fit correctly
• Reaction or sensitivity to contact lens solutions and cosmetics
• Scratches or scrapes on the surface of the cornea (called an abrasion)
• Something getting into the eye (such as sand or dust)
• Sunlight, sun lamps, snow or water reflections, or arc-welding

Infections may also damage the cornea.

You are more likely to develop a corneal injury if you:

• Are exposed to sunlight or artificial ultraviolet light for long periods of time
• Have ill-fitting contact lenses or overuse your contact lenses
• Have very dry eyes
• Work in a dusty environment

High-speed particles, such as chips from hammering metal on metal, may become embedded in the surface of the cornea. Rarely, they may pass through the cornea and go deeper into the eye.

Symptoms

• Being very sensitive to light
• Blurred vision
• Decrease in vision
• Eye pain or stinging and burning in the eye
• Feeling like something is in your eye, called a foreign-body sensation
• Redness of the eye, "bloodshot" eyes
• Swollen eyelids
• Watery eyes or increased tearing

Signs and tests

A complete eye exam must be done. The health care provider may use a special stain called fluorescein, placed on the surface of the eye.

Tests that are used to examine the eye for damage to the cornea include:

• Standard ophthalmic exam
• Slit lamp examination of the eye

Treatment

See: Eye emergencies for information on immediate first aid.

Anyone with severe eye pain needs to be evaluated in an emergency care center or by an ophthalmologist immediately.

Treatment for corneal injuries may involve:

• Removing any foreign material from the eye
• Wearing an eye patch or temporary bandage contact lens
• Using eye drops or ointments prescribed by the doctor
• Not wearing contact lenses until the eye has healed
• Taking pain medicines

An abrasion or foreign object that is large enough to damage the cornea may not be visible without proper magnification or special eye drops that stain the cornea. Abrasions will often feel like foreign bodies in the eye.

Support Groups

Expectations (prognosis)

Injuries that affect only the surface of the cornea normally heal very rapidly with treatment. The eye should be back to normal within 2 days.

Penetrating corneal injuries are much more serious. The outcome depends on the specific injury.

Complications

Severe corneal injury may require extensive surgery or a cornea transplant.

Calling your health care provider

Call your health care provider if the injury has not significantly improved in 2 days with treatment.

Prevention

• Wear safety goggles at all times when using hand or power tools or chemicals, during high impact sports, or in other situations where there is a potential for eye injury.
• Wear sunglasses designed to screen ultraviolet light when you are exposed to sunlight, even during the winter.
• Be careful when using household cleaners. Many household products contain strong acids, alkalis, or other chemicals. Drain and oven cleaners are particularly dangerous. They can lead to blindness if not used correctly.

References

Vinger PF. the eye and sports medicine. In: Tasman W, Jaeger EA, eds. Duane's Ophthalmology. 15th ed. Philadelphia, Pa: Lippincott Williams & Wilkions;2009:chap 45.

Cameron JD. Surgical and nonsurgical trauma. In: Tasman W, Jaeger EA, eds. Duane's Ophthalmology. 15th ed. Philadelphia, Pa: Lippincott Williams & Wilkions;2009:chap 6.

Sharma R, Brunette DD. Ophthalmology. In: Marx JA, ed. Rosen's Emergency Medicine: Concepts and Clinical Practice. 7th ed. Philadelphia, Pa: Mosby Elsevier; 2009:chap. 69.