Photoclinic: Corneal Abrasion

On waking up from a nap, a 5-month-old infant was noted to have a watery right eye. The mother thought an eyelash was the problem and flushed the eye with water. Soon afterward, the eye watered again and began to close. There was no history of injury, foreign body, upper respiratory tract symptoms, or fever.

The infant was alert, active, and in no distress. Vital signs were stable, and general physical examination findings were normal. Her right eye was partly closed. No foreign body was seen when the eyelid was everted. The pupil was round and reactive; the conjunctiva was mildly hyperemic. There were no scratches on the face.

After instilling proparacaine and fluorescein dye in the eye, Manu Madhok, MD, and Devi Meyyappan, MBBS, of Children's Hospitals of Minnesota in Minneapolis used a Wood lamp to examine the cornea. The uptake of fluorescein dye by damaged corneal epithelial cells revealed an abrasion.

Corneal abrasion is usually caused by a foreign body or direct injury from a fingernail, stick, or piece of paper.¹ Examination under a slit lamp or Wood lamp after staining with fluorescein dye reveals the denuded epithelium and confirms the diagnosis.

Topical antibiotic therapy for corneal abrasions is prescribed to prevent bacterial infection and a corneal ulcer. The use of a patch to treat a simple corneal abrasion does not improve healing rates and the patient is temporarily deprived of binocular vision. Therefore, patches are not routinely recommended in this setting.²

Follow-up with the infant's primary physician is usually adequate. When an abrasion is visible even without fluorescein staining or an ulcer is noted, antibiotic drops, patching, and close follow-up by an ophthalmologist are indicated.

Consider a corneal abrasion in infants with normal physical findings who cry inconsolably.³

The infant's long fingernails were thought to be the cause of her corneal abrasion. The mother was asked to trim the baby's nails, instill ofloxacin ophthalmic drops for 5 days, and prevent bright light from shining into the infant's eye. She was also instructed to bring the infant to the primary physician for follow-up in 1 week.

References:

REFERENCES:

1. Wirbelauer C. Management of the red eye for the primary care physician.

Am J Med.

2006;119:302-306.
2. Turner A, Rabiu M. Patching for corneal abrasion.

Cochrane Database Syst Rev.

2006. Apr 19;(2):CD004764.
3. Harkness MJ. Corneal abrasion in infancy as a cause of inconsolable crying.

Pediatr Emerg Care.

1989;5:242-244.