How to Treat a Corneal Abrasion

How to Treat a Corneal Abrasion

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How to Treat a Corneal Abrasion

A scratch or a corneal abrasion has several causes, including the use of contact lenses for a prolonged period, the insertion of chipped or broken LAC (contact lenses), the presence of a foreign body (such as an eyelash or a grain of sand), a shock / shock or a liquid that has entered the eye. The cornea performs a dual function: it collaborates with other components of the eye such as sclera, tears and eyelids to protect the eyeball and eliminate foreign particles and modifies the light rays that enter the eye helping the focus. Symptoms of a corneal abrasion include tearing, pain and redness of the eye, eyelid spasms, photophobia, blurred vision or a foreign body sensation. Fortunately, there are many solutions and remedies to allow the scratched cornea to heal.

Remove the Foreign bodies

1) Try to blinking.
Sometimes the scratches on the cornea are caused by small debris that remains trapped under the eyelid – grains of dust, sand, dirt and even an eyelash. Before starting to treat the abrasion, you must remove the cause. For this purpose try to wink consecutively for several times. The eyelid movement stimulates the lacrimal glands to produce a greater quantity of liquid which in turn “wash” the eye expelling the foreign body.
Pull the upper eyelid of the affected eye over the lower eyelid using the right hand. The lower lashes could “brush off” the irritant from the eye.
Do not attempt to remove the stuck fragments with your fingers, tweezers or other objects, as this may cause injury and worsen the situation.

2) Wash your eye.
If simple blinking has not led to the desired results, try washing the eye with water or saline. The best liquid to use is a sterile or saline solution. Do not use tap water. The ideal solution for an eyewash wash should have a temperature between 15 and 37.7 ° C and a neutral pH (7.0). Although there are several anecdotes that suggest this remedy, do not wash the eye by pouring the water with a glass or a cup, as this may trap the foreign body further. Follow these instructions to know how and for how long to wash the eye:
In the case of slightly irritating chemicals, rinse the eye for five minutes;
If the foreign body is moderately or severely irritating, wash the eyeball for at least 20 minutes;
For non-penetrating corrosive products, such as acids, the washing continues for 20 minutes;
In the case of penetrating corrosive products such as bases, rinse the eye for at least 60 minutes.
Take note of any additional symptoms that may indicate the presence of a poisonous solution in the eye – nausea or vomiting, headache or dizziness, diplopia or visual impairment, loss of consciousness or loss of consciousness, rashes or fever. If you show this symptomatic picture, call the anti-poison centre of your Region and go to the emergency room immediately.

3) Use artificial tears.
Another method of removing objects caught in the eye is to instil a humectant eye drop to wash the eye. It is a product widely available in pharmacies that do not require a prescription. You can instil it yourself or ask someone to help you. The correct technique for inserting eye drops is described in the third part of this article.
Artificial tears are designed to lubricate the eyes and keep the surface moist. They are widely available and there are many brands and types. Some products contain preservatives that can irritate the eyes after prolonged use. Preservatives can also create some discomfort if you apply moisturizing eye drops more than four times a day. If you need to use it more frequently, choose a product without preservatives.
Hydroxypropylmethylcellulose and carboxymethylcellulose are two common lubricants found in artificial tears and many over-the-counter eye solutions.
Sometimes the only method to find the most suitable product for your eyes is to proceed by trial and error. In some cases, it is even necessary to combine multiple eye drops of different brands. Patients suffering from chronic dry eyes should always use moisturizing products even when their eyes do not show symptoms. Artificial tears provide only additional help and do not replace natural tearing.                           3  JUNE 2018

ANDR HRUF —  000  555

4) If the scratch gets worse and does not heal, go to the ophthalmologist.
Once you have extracted the foreign body, the light scratch should heal by itself within a few days. However, severe abrasions or those that are infected need antibacterial eye drops to heal properly. Go to the ophthalmologist if:
Suspect that the foreign body is still in the eye;
You display any combination of these symptoms: blurred vision, redness, intense pain, tearing and extreme photophobia;
Themes of having a corneal ulcer (an open wound in the cornea) that is usually caused by an infection;
Note the presence of yellow, green or pus-sanguinolent secretions from the eye;
Perceive flashes of light, small dark objects or shadows that float in front of the eye;
Have you got a fever?

Allow the Eye to Heal

5) Get a formal diagnosis.
If you suspect a corneal injury, it is advisable to make an appointment with an eye specialist. The doctor will observe the cornea with an ophthalmoscope or a torch looking for a trauma. Most likely it will subject you to an examination by instilling into the eye of fluorescein, a dye that makes yellow tears. This product allows the eye doctor to see the abrasion under the light with greater clarity.
Generally, during this examination a topical anaesthetic is placed in the eye, so the doctor gently lowers the lower eyelid. Then a strip of fluorescein is placed on the surface of the eyeball and thanks to the winks the dye will spread throughout the eye. The areas of the ocular surface that are stained with yellow when exposed to normal light indicate the presence of corneal damage. The ophthalmologist will use a special cobalt blue light to highlight the abrasion and determine its cause.
A series of different vertical abrasions may be a sign of a foreign body, while branched spots indicate a herpetic keratitis. Several punctiform lesions, on the other hand, are usually caused by contact lenses.
The dye may interfere with your vision for a while and you may notice yellow halos for a few minutes. It is normal that in this phase the yellow liquid from the nose comes out.

6) Take an oral painkiller to control pain.
If the corneal ulcer causes you a lot of suffering, it is worth taking an over-the-counter medicine to counter it, such as paracetamol (Tachipirina).
Pain management is a fundamental aspect because physical suffering causes stress, which in turn prevents the body from healing quickly and effectively.
Always take pain medication according to the instructions in the leaflet and never exceed the recommended dose.

7) Do not put a patch or eye patch.
In the past these dressings were used to help the eye heal after an abrasion; however, recent clinical studies have shown that their presence increases pain and prolongs recovery time. The ocular patch prevents physiological winks by straining the eyelids and causing pain. They also trigger abundant tearing, create the ideal environment for the proliferation of bacteria and delay recovery.
Ocular bandages decrease the supply of oxygen to the eye and the cornea strongly depends on the oxygenation it receives from the environment.

8) Learn about alternatives to eye patches and bandages.

Currently, ophthalmologists are more likely to prescribe non-steroidal anti-inflammatory eye drops in combination with soft therapeutic contact lenses. Eye drops help reduce corneal sensitivity and contact lenses act as protection by speeding up the healing process and reducing related pain. Unlike the patches, this therapeutic approach allows you to see with both eyes while reducing inflammation. The most used ointments and eye drops contain both topical NSAIDs (non-steroidal anti-inflammatories) and antibiotics.
NSAIDs for topical use: try diclofenac (Voltaren) at 0.1%. Instil a drop in the injured eye four times a day. You can also use ketorolac (Acular) in 0.5% solution by putting a drop four times a day. To learn how to instil eye drops, read the third part of this tutorial. Remember to always follow the instructions and dosage reported on the packaging of the drug.
Antibiotics for topical use: use bacitracin in ophthalmic ointment inserting a strip of 1.3 cm from two to four times a day. You can also try 1% chloramphenicol (both in eye drops and in the ointment) and instil two drops every three hours. Another solution is given by ciprofloxacin in a 0.3% solution, the dosage of which changes during the treatment cycle. During the first day of treatment, you will need to insert two drops every 15 minutes for a total of six hours and then switch to two drops every 30 minutes for the rest of the day. On the second day, you need to instil two drops every hour; from the third to the fourteenth day you can put two drops every four hours. Always follow the indicated dosage on the leaflet.

9) Do not put make-up.
Applying eye makeup, such as mascara or eyeliner, further irritates the injured eye and delays healing. For this reason, you must avoid makeup until the abrasion has completely resolved.

How to Treat a Corneal Abrasion

10) Wear sunglasses.
It’s worth using them while you’re healing the scratched cornea to protect the eye and limit sensitivity to light. Sometimes corneal abrasions cause photophobia, but you can limit this unpleasant feeling by wearing UV-protected sunglasses even when you are indoors.
If you show extreme sensitivity to light or eyelid spasms, the ophthalmologist may also decide to prescribe eye drops that dilate the pupil. This reduces pain and relaxes the eye muscles. Again, read the third part of the article to learn how to instil mydriatic eye drops.

11) Do not wear contact lenses (LAC).
Do not put them until the eye doctor confirms that you can do it safely. If you usually rely only on this optical correction, you should avoid it for at least a week after the formation of the abrasion or until the cornea is completely healed.
This detail is particularly important in case the abrasion was caused precisely by the LAC.
You should not wear contact lenses while applying the antibiotic in the eye. Wait at least 24 hours after the last dose of medication before inserting them again.

Use the eye drops

12) Wash your hands.
Clean with scruple using antibacterial soap, before instilling the eye drops. It is very important to avoid introducing bacteria into the injured eye, otherwise, an infection may develop.

13) Open the bottle.
Once opened, throws the first drop of liquid. This operation prevents any residues or dust on the tip of the dropper from entering the eye.

14) Tilt your head back and hold a handkerchief under the affected eye.
The tissue will absorb the excess liquid that will come out of the eye. It is better to tilt the head back to exploit the force of gravity so that the drug penetrates across the ocular surface instead of coming out immediately.
You can instil the eye drops by standing, sitting or lying down; the important thing is that the head is tilted backwards.

15) Put the eye drops.
Look up and use the index finger of the non-dominant hand to lower the lower eyelid of the injured eye. Drop the medication into the conjunctival sac of the lower eyelid.
Regarding the number of drops to be administered, follow the instructions on the package or those provided by the ophthalmologist. Do not exceed the recommended dose.
If you need to instil more than one drop, wait a few minutes between them to make sure that the first one has been completely absorbed and is not “washed away” by the next one.
Do not let the tip of the dropper come into direct contact with the eyeball, eyelid or eyelashes because you could contaminate the eye.

16) Close your eye.
Once the drug is inside, close your eyelids gently for thirty seconds. You can keep the eye closed for up to two minutes. In this way you allow the active ingredient to spread inside the eyelid preventing it from going out.
Just remember not to wring the eyelids too hard, otherwise, you would push the drug out of the eye and damage the latter.

17) Tampon the surrounding area.
Use a soft cloth or tissue and gently dab the closed eye to absorb excess fluid.

Avoiding Corneal Abrasion

18) Wear a face mask during specific activities.
Unfortunately, when you suffer from corneal abrasion for the first time, there is a greater chance of getting injured again. For this reason, it is important to take all the necessary precautions to protect the eyeballs from foreign bodies and wounds. For example, studies have shown that wearing safety goggles reduces the risk of injury at work by 90%. Consider wearing a mask or at least protective glasses when performing these activities:
Practice sports such as softball, paintball, lacrosse, hockey and racquetball.
Work with chemicals, electrical tools or any other material that could splash into the eyes.
Mowing the lawn and tearing the weeds.
Drive a convertible car, a motorcycle or a bike.

19) Do not wear contact lenses for prolonged periods.
In this way, the eyes dry more easily and therefore are more likely to injure. You should use the LAC only for the maximum time recommended by your ophthalmologist.
Plan your day so you do not have to keep LAC all day. For example, if you go running in the morning and you know you want to go out on a bike in the evening, then wear glasses between these two activities, for example, while working on your computer. Make a conscious effort to always bring your glasses with you and replace them with contact lenses when the time comes.

20) Use artificial tears to keep your eyes hydrated.

Humectant eye drops can also be instilled after the abrasion has resolved. In this way, you not only lubricate the ocular surface but “wash away” any foreign body (like an eyelash) before it can scratch the cornea.

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