Fingernail-induced corneal abrasion — two hours old

ICD-10 Diagnosis Codes:

S05.01XA–Corneal abrasion, initial encounter, right eye
S05.01XD–Subsequent encounter, right eye
S05.01XS–Sequela of corneal abrasion, right eye
S05.02XA–Corneal abrasion, initial encounter, left eye
S05.02XD–Subsequent encounter, left eye
S05.02XS–Sequela of corneal abrasion, left eye

Superficial Injury of Cornea

Superficial Injury Of Eye And Adnexa

A corneal abrasion is a scratch or scrape of the cornea. It can result from foreign bodies, contact lenses, chemicals, or anything causing mechanical trauma such as fingernails, hair brushes, vegetative matter, dust, metal shards or projectile objects.

Corneal abrasions are defined as injuries to the most superficial layer of the cornea, the epithelium.

DG9181Pic200 Conjunctival Foreign Body-Induced Corneal Abrasion

  • Foreign body embedded under the upper eyelid
  • Eyelid eversion is necessary to determine the etiology

Structural Damage to the Eye 

  • Damage of the cornea at a superficial level — break does not involve Bowman’s membrane
  • Damage of the corneal at a deeper level — break penetrates Bowman’s membrane, but does not rupture Descemet’s membrane


Functional Damage to the Eye 

  • Blurred vision as a result of the compromised cornea 
  • Corneal edema can result from the insult to the cornea depending on the level of damage

The main goal of the diagnostic evaluation of a patient with corneal abrasion is to accomplish the following:

  • Assess the amount of structural damage to the cornea
  • Reduce patients symptoms
  • Manage pain accordingly
  • Prevent further damage to the cornea
  • Reduce re-occurrence of damage to the cornea during the healing process

Patient History

Patients with corneal abrasion may present with any of the following clinical symptoms:

  • Acute pain
  • Tearing
  • Photophobia
  • Blurred vision
  • Foreign body sensation
  • Blepharospasm
  • Pain with eye movements

External Ocular Examination with Biomicroscopy

  • Measure the size of the abrasion by using fluorescein dye
  • Evaluate the anterior chamber for signs of ocular inflammation (e.g., cells and flare)
  • Rule out penetrating trauma
Clinical Appearance of the Eyelid

  • First, evert the upper eyelid and scrutinize the palpebral conjunctiva, the ocular surface and conjunctival fornices to rule out the presence of foreign material
Clinical Appearance of the Conjunctiva

  • Vegetative matter embedded on the upper tarsus
  • Foreign bodies trapped under the upper eyelid tend to produce vertically-oriented linear abrasions
Clinical Appearance of the Cornea

  • Evaluate the cornea with fluorescein dye to determine the size, shape, location and depth of the corneal abrasion (superficial versus deep penetration)


External Ocular Photography 

  • Used to document degree of corneal damage

Two categories of corneal abrasions can occur:  superficial or deep abrasions.

Superficial abrasions do not involve Bowman’s membrane.

CT_ICD9_918-1_Pic05_062809 CT_ICD9_918-1_Pic04_062809

Deep abrasions
penetrate Bowman’s membrane, but do not rupture Descemet’s membrane.

Recurrent Corneal Erosions

  • The symptoms of pain, discomfort and photophobia are the same; however the etiology of the corneal damage is very different (the case history is very important in differentiating the two)
  • Corneal abrasions are usually caused by foreign bodies, contact lenses, chemicals, or some form of trauma
  • Recurrent corneal erosion happen from rubbing their eyes or opening their eyes or upon awakening from sleep — usually months after a history of a corneal abrasion from some mechanical trauma


Corneal Ulcers 

  • The symptoms of pain, discomfort and photophobia are similar, but patients with ulcers also report redness, watery eyes or mucopurelent discharge as well
  • Usually there is a history of contact lens wear or some form of trauma left untreated to develop into a corneal ulcer


Herpes Simplex Keratitis

  • The symptoms of pain, discomfort and photophobia are the same; however the etiology of the corneal damage is very different (the case history is very important in differentiating the two)
  • Patients with Herpes simplex will not report an initiating insult that caused the corneal damage

Treatment options vary depending on the cause of the corneal abrasion.  Patients with contact lens-induced abrasions must have anti-pseudomonas coverage.  

Phamacologic Therapy — Cycloplegia

Traumatic iritis may develop one-to-three days after the initial injury.  Use cycloplegics only because steroids may delay epithelial healing and increase the risk of corneal infection.  

  • Atropine 1% for severe abrasions 
  • Homatropine 5% for moderate abrasions 
  • Cyclopentolate 1% for mild abrasions


Pharmacologic Therapy — Topical Antibiotic

  • Fourth generation fluoroquinolones (Vigamox, Zymar, Ocuflox, Quixin, Besivance) for large abrasions 
  • Polytrim, Gentamycin, Tobramycin for small abrasions
  • Ointments or drops may be used, but ointments offer better barrier function and lubrication between the eyelid and the cornea


Pharmacologic Therapy — Topical NSAID (for pain) 

  • Acular LS, Nevanac or Prolensa if necessary


Pharmacologic Therapy — Oral Medication

  • Oral acetaminophen
  • Oral narcotics in severe cases


Surgical Therapy — Amniotic Membrane Placement 

  Corneal Abrasion

  • 78-year-old woman pokes herself in the eye while putting on her eyeglasses
  • Waits 48 hours to seek eye care
  • Presents as an emergency examnation with moderately-severe ocular pain, photophobia, hyperlacrimation, conjunctival hyperemia and a secondary ptosis
Corneal Abrasion

  • Treat with amniotic membrane therapy to promote cell migration

Surgical Therapy — Epithelial Debridement

CT_ICD9_371-42_Pic04_080809   Abrasion Associated with Loose/Hanging Corneal Epithelium

  • Loose tissue may delay corneal healing
  • Remove loose epithelium with cotton-tipped applicator, surgical sponge or Alger brush

Mechanical Therapy — Pressure Patching

  • Patching is usually not necessary
  • Consider patching if the abrasion is large, if the patient’s discomfort is severe, and/or if the abrasion is healing poorly in the absence of infection

1-day examination

  • Assess cornea, determine if patient needs to be patched for a second day
  • Consider bandage contact lens


Mechanical Therapy — Bandage Contact Lens

  • Low water content bandage contact lens for moderate-to-severe abrasion to relieve pain
  • Bed rest, inactivity and OTC analgesics
  • Prophylactic topical antibiotics should be used while bandage contact lenses are worn

1-day examination

  • Assess cornea, alter topical regimen as appropriate, determine if bandage contact can be removed
  • Determine if a hypertonic therapy (sodium chloride 2% or 5% drops/ointment) needs to be added to treat any secondary corneal edema

1.  Shah C, Ehlers J.  The Wills Eye Manual (fifth edition):  Corneal Abrasion. 2008; 15-16.