Corneal Abrasion: How To Treat A Scratched Eye
A corneal abrasion (scratched cornea or scratched eye) is one of the most common eye injuries. A scratched cornea often causes significant discomfort, red eyes and hypersensitivity to light. Corneal abrasions result from a disruption or loss of cells in the top layer of the cornea, called the corneal epithelium.
The cornea is the clear front surface of the eye, and part of its job is to focus light, enabling you to see. A healthy cornea is essential for good vision. In addition to disrupting vision, a scratched cornea makes your eye more susceptible to infection. So it's important that you see your eye doctor or visit an emergency room or urgent care center as soon as possible if you suspect you have a corneal abrasion.
What Causes Corneal Abrasions?
There are countless ways to get a corneal abrasion. No matter how big or small, anything that makes contact with the surface of your eye can cause injury.
A corneal abrasion is a painful scratch on the clear front surface of the eye.
Tree branches, paper, makeup brushes, a pet, a finger, workplace debris, sports equipment and more all pose a danger to the front surface of your eyes.
Many corneal abrasions aren't caused by a noticeable traumatic event, such as getting poked in the eye. Sand, dust and other small particles can cause a corneal abrasion as well, especially if you rub your eyes.
Dry eyes can increase your risk of a corneal abrasion, particularly when awakening from sleep. If your eyes dry out while you are sleeping, your eyelids may stick to your cornea. When you wake up and open your eyes, your lids can tear and dislodge a portion of the outer layer of the cornea (epithelium), causing a painful abrasion.
Contact lenses usually won't protect your eyes from corneal abrasions. In fact, if your contacts are damaged or you wear them too long, they may even increase your risk of a scratched cornea.
Symptoms Of A Scratched Cornea
The cornea is one of the most sensitive parts of your body, so even a very small corneal abrasion can be extremely painful and feel much larger in size — as if you have a big, rough object in your eye.
In addition to pain and a gritty or foreign body sensation, other signs and symptoms of corneal abrasions include redness, tearing, light sensitivity, headache, blurry or decreased vision, eye twitching, a dull ache and, occasionally, nausea.
If you think you may have suffered a corneal abrasion and are experiencing any of these symptoms, seek medical attention right away.
What To Expect
People have a tendency to rub their eyes when they feel like something is "in" them, but this can make matters much worse. If you get something in your eye, you can attempt to flush it out with water, but don't rub your eye. Don't patch it either, since this can speed bacterial growth and increase the risk of an eye infection.
A cornea abrasion usually affects just one eye, and it can feel like something is on or in your scratched eye.
If possible, rinse your eye with a sterile saline eye wash or a multipurpose contact lens solution rather than tap water or bottled water. Microorganisms such as Acanthamoeba have been found in tap water and even bottled water, and these pathogens can cause a serious, vision-threatening infection if introduced to an eye with a scratched cornea.
After flushing the eye, if redness, pain or foreign body sensation continues, seek immediate attention because corneal abrasions can cause serious harm in as little as 24 hours.
To diagnose a corneal abrasion, your optometrist or ophthalmologist may apply an eye drop to numb your eye so you can keep it open for the exam. Another type of eye drop may be used to help your doctor see the extent of the abrasion when viewing your eye with a blue light and an examining microscope called a slit lamp.
Depending on what may have caused the scratch and what your doctor sees during the exam, your eye might be gently swabbed for a culture to ensure proper treatment in the event of infection.
Treatments For A Scratched Eye
Treatment for a corneal abrasion depends on the severity of the wound and the cause. Minor abrasions sometimes can be treated with non-preserved lubricating drops to keep your eye moist and comfortable while your eye's natural healing process takes place.
As a precaution, even superficial abrasions sometimes are also treated with antibiotic eye drops to prevent infection during healing. Superficial corneal abrasions tend to heal quickly, usually within two or three days.
But other corneal abrasions may require an antibiotic ointment that stays on the eye longer, a steroid to decrease inflammation and scarring, and something to relieve pain and light sensitivity. Large, deep corneal abrasions take longer to heal and can cause a permanent scar that might affect vision.
When treated right away, most corneal abrasions result in a full recovery. But untreated abrasions can lead to severe vision loss.
In some cases, scratched corneas are treated with what's known as a bandage contact lens. When used with prescription eye drops, these special lenses provide pain relief and sometimes can speed healing.
Typically, regular contact lenses should not be worn over a corneal abrasion because of increased risk of an infection developing under the lens. Your eye doctor will tell you when it's safe to resume wearing your contacts following a scratched cornea.
Depending on the treatment and severity of the injury, your optometrist or ophthalmologist may schedule a follow-up exam as soon as 24 hours after initial treatment.
When treated right away, most corneal abrasions result in a full recovery with no permanent vision loss. But some deeper abrasions that occur in the center of the cornea (directly in front of the pupil) can leave a scar and result in a loss of visual acuity.
If left untreated, some deep corneal abrasions can lead to a corneal ulcer that can cause severe vision loss. Abrasions caused by organic matter, in particular, can increase the risk of corneal ulceration.
Attending your follow-up appointments is very important, because corneal abrasions don't always heal properly and can lead to recurrent corneal erosions and other complications that can affect your vision and comfort.
How To Prevent A Scratched Eye
Although many causes of corneal abrasions are difficult to prevent, others can be avoided by taking some simple, common-sense precautions.
For example, always wear safety glasses or protective goggles in work environments with airborne debris, particularly in welding environments. Likewise, protective eyewear should be used when doing yard work, using power tools and playing sports.
If you wear contact lenses, always follow your eye doctor's instructions regarding how long to wear them, when to discard them, and the proper contact lens care solutions to use to help keep your corneas healthy and strong.
If you experience a corneal abrasion that appears to be related to dry eyes, see your eye doctor for a detailed evaluation of the front surface of your eyes and, if necessary, follow the dry eye treatment protocol your doctor recommends.
About the Author: Amy Hellem is a writer, editor and researcher who specializes in eye care and other medical fields. She is a past editor-in-chief of the professional ophthalmic journals Review of Optometry and Review of Cornea & Contact Lenses and currently is president of Hellem Consulting, LLC.
Page updated November 2016