View source for Corneal laceration

''For full-thickness corneal lacerations see [[globe rupture]]''
==Background==
[[File:Schematic diagram of the human eye en.png|thumb|Eye anatomy.]]
*Traumatic injury to the eye, most often associated with penetrating injury or impact with debris.<ref>[https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6014923/], Ramirez DA. Ocular Injury in United States Emergency Departments: Seasonality and Annual Trends Estimated from a Nationally Representative Dataset. Am J Ophthalmol. 2018;191:149-155.</ref>  
*Must rule out full-thickness corneal laceration (i.e., [[globe rupture]]), which is a medical emergency  

==Clinical Features==
*Foreign body sensation
*Photophobia (+/- consensual)
*[[Vision loss|Decreased vision]]
**If associated iritis or if abrasion occurs in visual axis
*[[Eye pain]]
**Relief of [[eye pain|pain]] with topical anesthesia

==Differential Diagnosis==
{{Unilateral red eye DDX}}

==Evaluation==
===Workup===
*A complete [[Eye Exam|eye exam]] should be conducted
*Eyelid Exam
**Flip upper lid and exam lower lid for foreign body
**If concern for foreign body despite normal exam, consider orbital CT (or MRI if certain foreign body is nonmetallic)
*Fluorescein Exam
**Apply 1 gtt of flourescein or use strip with anesthetic
**Use Wood's lamp or [[slit lamp]] with cobalt blue light
**Fluorescein will fill corneal defects and glow
**Multiple vertical abrasions suggests foreign body embedded under the upper lid
*Topical anesthetic (i.e., proparacaine or [[tetracaine]]) may assist in patient cooperation with exam once open globe excluded.
**Repeated doses or prescriptoin for topical anesthesia is controversial given concerns for impaired healing

===Corneal laceration (non full-thickness) vs Globe Rupture===
[[File:PMC3038515 IJO-59-131-g007.png|thumb|Positive Seidel’s test (see [[globe rupture]]).]]
*Fluorescein Examination
**Seidel sign (streaming of fluorescein) indicates [[globe rupture]]
*If high-risk metallic foreign body injury (e.g., hammering a nail, grinding metal), perform ocular CT on all patients
*Normal ocular pressure (do not perform if high suspicion of [[globe rupture]]) supports simple (non full-thickness) corneal laceration diagnosis

===Diagnosis===
*Typically determined on clinical exam +/- ocular CT (if high risk)

==Management==
''See [[globe rupture]] for full thickness lacerations.''

===Antibiotics===
{{Corneal Abrasion Antibiotics}}

===[[Analgesia]]===
*Systemic [[NSAIDs]] or [[opioids]]
*[[Cycloplegic]]s can be consider for patients with large abrasions (>2mm) and/or severe pain
**[[Cyclopentolate]] 1% 1 drop q6-8hr
*Ophthalmic [[NSAIDs]]
**[[Ketorolac]] 0.4% 1 drop q6hr x 2-3d
*Topical anesthetics
**[[Tetracaine]] 1% 1 drop q30min has been found to be safe in the first 24 hrs<ref>Waldman N, et al. Topical tetracaine used for 24 hours is safe and rated highly effective by patients for the treatment of pain caused by corneal abrasions: a double-blind, randomized clinical trial. Acad Emerg Med. 2014; 21(4):374-82.</ref>
**Proparacaine 0.05% ophthalmic (dilute 1 mL of proparacaine 0.5% with 9 mL of NS in flush syringe then place 3 mL in bottle) 1-2 drops in eye Q30 min PRN pain for 24-48 hours only<ref>Salim Rezaie, "Topical Anesthetic Use on Corneal Abrasions", REBEL EM blog, April 21, 2014. Available at: https://rebelem.com/topical-anesthetic-use-corneal-abrasions/.</ref>

===Other===
*[[Tetanus prophylaxis]] not indicated (unless penetrating injury)<ref>Mukherjee P, et al. Tetanus prophylaxis in superficial corneal abrasions. Emerg Med J. 2003; 20:62-64.</ref>
*Patch is not routinely recommended<ref>Flynn CA, et al. Should we patch corneal abrasions? A meta-analysis. J Fam Pract. 1998; 47(4):264-70.</ref> and can prolong healing time<ref>Fraser, S. Corneal abrasion. Clin Ophthalmol. 2010; 4:387-390.</ref>

==Disposition==
''(Assuming '''no''' [[globe rupture]])''
*Ophtho follow up in 48h for routine cases

==See Also==
*[[Corneal abrasion]]
*[[Ocular foreign body]]
*[[Open globe]]
*[[Eye Algorithms (Main)]]

==External Links==


==References==
<references/>

[[Category:Ophthalmology]]