Wounds1

Corneal Abrasion and Hyphema

Quick Reference

Eye trauma, defined as any injury to the eye, is responsible for one third of all cases of vision loss in children 10 years or younger. Corneal abrasion is the most common type of eye trauma, and results from a scratch or wounding of the cornea, or convex outer surface of the eye. Another more serious form of eye trauma is known as hyphema, which is characterized by a pooling of blood in the front section of the eye. Both of these conditions require attention by a physician or ophthalmologist, but are treatable.

Detailed Description

Corneal abrasions may result from a wide range of events, including the presence of a foreign object in the eye, a scratch from an external source or even the prolonged use of contact lenses. Although corneal abrasions are usually caused by physical contact to the eye, inadequate eye protection from UV light or prolonged sunlight exposure can also damage the eye. Sufferers may experience pain and redness of the eye, excessive tearing and blinking, and sudden sensitivity to light. Additionally, blurry vision, and pain during reading or other activities requiring increased eye motion are fairly common.

Hyphema may be caused by the same types of physical trauma as corneal abrasions, or can result from other existing medical conditions. These include ophthalmic surgery, rubeosis iridis (abnormal blood vessel growth in the iris), vitreous hemorrhage (the presence of blood in the gel fluid behind the eye), blood dyscrasias (when the ingredients of the blood are irregular, such as in hemophilia), and neoplasia (abnormal or uncontrolled growth of tissue). Moreover, individuals taking blood-thinning medications, such as coumadin or heparin, and diabetes patients are also at risk. Physical symptoms of hyphema are similar to those of corneal abrasion, with the addition of blood accumulation in the forward chamber of the eye.

Treatment

Treatment of corneal abrasions varies depending on the severity of injury. A physician can determine the extent of injury using a dye that identifies cells that are damaged or absent. Saline solution or warm water is used to flush any foreign object from the eye, and administration of antibiotic drops or ointment often follows. Reading and other activities requiring eye motion should be curtailed until the eye heals, and it is often helpful to avoid direct light or to wear sunglasses during this time. The use of an eye patch for 12-24 hours after removing the irritant is common, and helps immobilize the eye for ease of healing. Corneal abrasions usually heal quickly, within 24-48 hours after the wound occurs. If pain persists after 48 hours, temperature rises to or above 100ºC, or skin rash or nausea develops, follow-up with a physician is necessary. In cases where the abrasion is quite large, the eye should be re-examined every 2 days.

As with corneal abrasions, treatment of hyphema varies with the extent of injury. Antibiotic drops, an eye patch, bed rest and a prohibition on reading and similar activities may all be employed to cure hyphema. In addition, maintaining a bed elevation of 40º to aid the draining of blood from the eye is recommended. It is important to note that hyphema does not necessarily cause permanent harm, but the eye must be closely monitored for related complications. One such complication is glaucoma, which results from increased fluid pressure within the eye, and can lead to loss of vision. Others include blood staining of the cornea, reoccurrence of bleeding, and damage to the optic nerve due to an increase in fluid pressure. Topical beta-blockers, carbonic anhydrase inhibitors, isosorbide and mannitol are commonly used to maintain eye pressure at the appropriate level, and thus prevent many of these side effects.

Last updated: 11-Nov-02