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Corneal Injury: Emergency Management, Treatment, and Follow-Up

The cornea is the transparent, avascular anterior window of the eye. Injuries—abrasions, foreign bodies, chemical burns, lacerations, UV keratitis—require prompt, appropriate care to preserve vision.

Immediate First Aid

  1. Chemical Exposure: IRRIGATE IMMEDIATELY. Copious water/saline ≥20–30 minutes. Remove contact lenses. Do not delay for pH paper. Call 911 / proceed to ED.
  2. Foreign Body (Non-penetrating): Do not rub. Blink, tear, irrigate with saline. If not dislodged, see eye care professional.
  3. Penetrating / Perforating Injury: Do not irrigate, remove object, or apply pressure. Shield eye (fox shield or paper cup), stabilize, emergent ophthalmology.
  4. Flash Burn (UV): Symptoms delayed 6–12h. Cold compresses, lubricants, NSAIDs, cycloplegia; usually self-limited 24–48h.

Clinical Evaluation

  • Visual acuity, pupils, motility, IOP (if no open globe).
  • Slit-lamp with fluorescein: abrasion (green uptake), Seidel test (aqueous leak), FB, infiltrate.
  • Imaging (CT/B-scan) if intraocular FB or rupture suspected.

Standard Treatment

  • Abrasion: Topical antibiotic (erythromycin ointment, fluoroquinolone drops), cycloplegic for pain (cyclopentolate), oral analgesics. Patch controversial—many avoid for non-contact lens wearers.
  • Foreign Body: Removal at slit-lamp (spud, needle, burr). Rust ring → burr removal. Antibiotic prophylaxis.
  • Chemical Burn: Intensive irrigation until pH 7.0–7.2; topical antibiotics, steroids (early, short course), citrate, ascorbate, cycloplegics, amniotic membrane, autologous serum. Admit severe (Grade III–IV).
  • Laceration / Rupture: Surgical repair (10-0 nylon) in OR. Systemic antibiotics, antifungals if organic matter.

Follow-Up

  • 24h for abrasion/FB; daily for chemical burns; per surgeon for surgical repairs.
  • Monitor for infection, ulceration, scarring, irregular astigmatism, glaucoma.
  • Contact lens wearers: higher Pseudomonas risk; fluoroquinolone mandatory; no CL until healed.

Prevention

  • ANSI Z87.1 safety glasses/goggles for work, sports, yardwork.
  • Chemical splash goggles for lab/cleaning.
  • Proper contact lens hygiene.

Corneal injuries are ophthalmic emergencies. Timely, correct action saves vision.

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