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Corneal Abrasion and Ulceration

Corneal Abrasion and Ulceration is a topic covered in the 5-Minute Clinical Consult.

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Basics

Description

  • Corneal abrasions: result from cutting, scratching, or abrading the thin, protective, clear coat of the exposed anterior portion of the ocular epithelium. These injuries cause pain, tearing, photophobia, foreign body sensation, and a gritty feeling (1).
  • Corneal ulceration: break in the epithelial layer of the cornea leading to exposure of the underlying corneal stroma, which results in a corneal ulcer. Superficial ulcers, limited to loss of the corneal epithelium, are the most common form of ulceration (2).
  • Corneal abrasion and ulceration can both lead to impaired vision from scarring.

Epidemiology

Incidence
  • Corneal abrasions are commonly seen in primary care. Eye-related diagnoses make up 8% of total ER visits. Of those eye-related visits, 45% are corneal abrasions. Abrasions are the third leading cause of red eye, following conjunctivitis and subconjunctival hemorrhage (3).
  • Associated with significant morbidity and loss of productivity

Etiology and Pathophysiology

  • Corneal abrasions are most often caused by mechanical trauma but may also result from foreign bodies, contact lenses wear, or chemical and flash burns.
  • Corneal ulceration: Contact lenses use, HIV, trauma, ocular surface disease, and ocular surgery increase the incidence. Edema plays a major role in epithelial defect. Edema can lead to trauma, ischemia, and increased intraocular pressure. Excessive fluid disrupts the normal architecture of the epithelial layer (4).
  • Causes of ulcerations include the following:
    • Infection with gram-positive organisms ~29–53% (Staphylococcus aureus and coagulase-negative Streptococcus are common ones)
    • Infection with gram-negative organisms ~47–50% (Pseudomonas being most common, followed by Serratia marcescens, Proteus mirabilis, and gram-negative enteric bacilli)
  • Increased risk of corneal ulceration in HIV and diabetes mellitus (DM) patients and immunocompromised

Risk Factors

  • History of trauma (direct blunt trauma, chemical burn, radiation exposure, etc.)
  • Contact lenses wear
  • Male gender
  • Age: 20 to 34 years old
  • Job (construction, manufacturing)
  • Lack of eye protection

General Prevention

Protective eyewear during work (automechanics, metal workers, miners, etc.) and during sports

Commonly Associated Conditions

  • Vitamin A deficiency is associated with corneal ulcers.
  • Neuropathy of cranial nerve (CN) V
  • DM, thyroid dysfunction, immunocompromised states, connective tissue disease

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Citation

Stephens, Mark B., et al., editors. "Corneal Abrasion and Ulceration." 5-Minute Clinical Consult, 27th ed., Wolters Kluwer, 2019. Medicine Central, im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/116946/all/Corneal_Abrasion_and_Ulceration.
Corneal Abrasion and Ulceration. In: Stephens MB, Golding J, Baldor RA, et al, eds. 5-Minute Clinical Consult. 27th ed. Wolters Kluwer; 2019. https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/116946/all/Corneal_Abrasion_and_Ulceration. Accessed April 19, 2019.
Corneal Abrasion and Ulceration. (2019). In Stephens, M. B., Golding, J., Baldor, R. A., & Domino, F. J. (Eds.), 5-Minute Clinical Consult. Available from https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/116946/all/Corneal_Abrasion_and_Ulceration
Corneal Abrasion and Ulceration [Internet]. In: Stephens MB, Golding J, Baldor RA, Domino FJ, editors. 5-Minute Clinical Consult. Wolters Kluwer; 2019. [cited 2019 April 19]. Available from: https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/116946/all/Corneal_Abrasion_and_Ulceration.
* Article titles in AMA citation format should be in sentence-case
TY - ELEC T1 - Corneal Abrasion and Ulceration ID - 116946 ED - Stephens,Mark B, ED - Golding,Jeremy, ED - Baldor,Robert A, ED - Domino,Frank J, BT - 5-Minute Clinical Consult, Updating UR - https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/116946/all/Corneal_Abrasion_and_Ulceration PB - Wolters Kluwer ET - 27 DB - Medicine Central DP - Unbound Medicine ER -