Case Study: Corneal Abrasion

Introduction  As nurse practitioners, we often spend little time learning about the eye in our NP programs however we are expected to treat patients with eye illness and injury in the clinic and hospital setting.  It is important to familiarize yourself with opthalmologic conditions and treatment because with the eye there are many conditions you don’t want to miss!

Case Presentation

A 24 year old male patient presents to the urgent care clinic with a complaint of right eye pain.  This patient states he was mowing the lawn and a small piece of debris flew up and hit him in the eye.  He sates it “feels like there is something still in there”.  Since the incident the vision in his right eye has been blurred and he is sensitive to light.
This patient’s vital signs are all within normal limits.

This patient denies any previous medical history including problems with the eye.  He does not wear contacts or glasses and believes his normal vision to be near 20/20.

On exam you find this patient’s right eye appears erythematous.  He keeps his eye closed in the exam room and when you instruct him to open the eye it appears to be painful.  He also exhibits signs of photosensitivity.  He has tearing from the right eye but no purulent discharge.  Visual acuity in the left eye is 20/25, acuity in the right eye is 20/60.  To examen this patient's eye more completely, the upper and lower lids are retracted.  No foreign body is noted.  Upon examination with fluorescein stain and a Wood’s lamp, you note a small abrasion to the cornea.

Based on this patient’s history and exam, he is diagnosed with a corneal abrasion.

Differential Diagnoses

Differential diagnoses for erythema of the eye include acute angle-closure glaucoma (don’t miss this!), blepharitis, corneal foreign body, corneal ulceration, ulcerative keratitis, conjunctivitis, iritis and uveitis.

Discussion

Patients with corneal abrasion usually present with an injury to the affected eye and a foreign body sensation.  Contact lenses are the most common cause of corneal injury.  Corneal abrasions present in varying degrees from a superficial scratch to the surface of the eye to deep abrasions that may cause ulceration.  Severe abrasions can heal poorly and result in chronic vision changes and should be referred to an ophthalmologist.

Management and Outcome

Corneal abrasions heal with time, usually in a few days.  Prophylactic antibiotic drops are also used to prevent infection to the injured area.  Some clinicians use patching for pain relief, however research studies have not shown this to be effective.  Patches should not be used on patients at high risk for infection.  Oral narcotic pain medications are typically required initially for pain control.  Emergent opthalmologic consultation is necessary if retained foreign body or corneal ulceration is suspected.
 

References

Verma, Arun, Corneal Abrasion, Medscape Reference, http://emedicine.medscape.com/article/1195402-overview.

Comments

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