Goals

To assess for the presence of a corneal abrasion and rule out causes of red eye with similar presenting symptoms that would require urgent ophthalmology referral.

Background

The cornea is the transparent, outer most layer of the eyeball. The cornea covers the iris and pupil and plays a role in focusing incoming light rays to the retina. The cornea is protected by the eyelids, but is susceptible to injury, especially from trauma. A corneal abrasion is the result of superficial or deep loss of the top layer of the corneal epithelium due to scratching or cutting by a foreign body. Due to the rich nerve supply of the cornea, patients often present with severe pain, foreign body sensation, and photophobia. Examination for a corneal abrasion is done with the use of fluorescein stain as part of a comprehensive eye exam.

Contraindications

The following situations warrant urgent ophthalmology referral:

• Penetrating trauma
• Suspected intraocular foreign body
• Nonreactive or an irregular pupil
• Suspected infectious infiltrate (e.g., herpes simplex virus keratitis)