First Aid Management of Corneal Scratch (Abrasion)

Cornea is the transparent outer most layer covering the iris (colored part) and the pupil (black circle in the middle) of the eye. It is an essential area of the eye for the vision and also it acts as a protective barrier for the delicate inner structures. Most of the eye injuries occur in cornea due to its prominent position; most of them are small superficial scratches and are called as corneal abrasions.

Some of these corneal abrasions can get infected subsequently and become corneal ulcers. Corneal ulcer is a serious condition which left untreated can invariably cause permanent blindness.

Though corneal abrasions almost always require specialist attention, it is worthy to have the knowledge on identifying a corneal abrasion at community level during first aid training. Few simple first aid measures can reduce the damage done to the cornea and can minimize the chances of an abrasion getting infected. Also this knowledge can be used to employ preventive measures to protect eyes in various scenarios in day to day life.

Common causes

• Jabbing finger into eye
• Foreign body
• Contact lenses
• Walking in to tree branches
• Excessive rubbing of eyes
• Welding light exposure
• Over exposure to ultra violet light
• Makeup brushes
• Edge of a piece of paper
• Chemical burns
• Eye lashes falling in to cornea
• Medical conditions causing dry eyes (e.g. Sjögren’s syndrome)
• Inability to fully close eye lids (e.g. facial nerve palsy)
• Abnormalities of eye lid position (e.g. entropian – inversion of eyelids)

Signs and symptoms of corneal abrasion

• Pain
• Discomfort in eyes
• Foreign body sensation – feeling like sand in eyes
• Blurring of vision
• Tearing
• Redness
• Photophobia – inability to look at bright lights
• Visible epithelial defect
• Swelling
• Headache
• Symptoms of a corneal abrasion may not occur immediately. This delays the presentation and makes it hard to identify what has caused the abrasion.
• The exact diagnosis of corneal abrasion is established by ophthalmoscopy and slit lamp examination.
• Most simple corneal abrasions will heal without any active medical intervention and with the time.

First aid Management

1. Calm down the patient.

2. Do not allow rubbing the injured eye; otherwise it will cause serious damage. Keep the eye closed as much as possible.

3. Try to wash out foreign material using clean water. Use a saline solution if available. Rinse the eye using an eyecup or a small clean drinking glass positioned with its rim resting on the bone at base of the eye socket.

4. Ask the victim to blink several times repeatedly. This may dislodge the object from cornea.

5. Pull upper eyelids over lower eyelids to remove any objects adhered to inner surface of upper eyelid.

6. If wearing contact lenses remove at once. Use a backup pair of glasses.

7. Use artificial tears to keep the moisture in the eyes.

8. Use dark glasses to protect from sun light.

9. Do not try to remove objects embedded in eyeballs.
10. Do not touch eyeballs with dirty hands, non-sterile cloths/cotton or with First Aid Management of Corneal Scratch (Abrasion)any instruments like tweezers.

11. Call for medical help if the victim has persistent pain, hit the eye with foreign material travelling high speed, recurrence of pain after first aid intervention, purulent discharge, and if there is any vision impairment.

Typical corneal abrasion

Prevention of corneal abrasions • Wearing protective glasses in risk situations.
• Be careful about makeup brushes.
• Taking good care on contact lenses.
• Do not sleep with contact lenses.
• Regular usage of artificial tears in dry eye conditions.
• Usage of recommended safety gear during work sites.

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