Corneal Abrasions and Ulcers

Disclaimer.  I am not a licensed health practitioner.  This is just another post on knowledge and understanding you might wish to acquire in advance of a disaster in case no higher care is available.  As long as our society is functioning, you should leave anything more substantial than applying a Band-Aid to the professionals.  No medication, including those available over the counter, should be taken without consulting a physician.  Information shared here is for educational and entertainment purposes only.  It is not medical advice nor a substitute for licensed medical care.  

 

OK, corneal abrasions and ulcers are conditions that I have unfortunately had some experience with.  I’ve done it with chemicals (the wrong contact lens solution) and mechanically (leaving a contact lens in for months).  No, I did not do that on purpose.  I don’t normally wear a lens in that eye, but had a senior moment one morning.  I immediately tried getting it out.  Tried and tried and tried.  I finally decided that it must have fallen out because I couldn’t see it in there and figured I must have gotten it at some point and then dropped it on the floor.  Anyway, a few months later (and I never had any problems with dry eye like I normally do if I leave a lens in for too long) I was in the ER in extreme pain.  The lens finally caused a corneal ulcer and infection.  A corneal abrasion is a mere scratch on the cornea.  A corneal ulcer penetrates the cornea a bit deeper.  Both injuries are extremely painful.

Corneal abrasions and ulcers can be caused by any number of objects or conditions:

• Eyelashes
• Contact lenses
• Sand and dirt
• Sawdust
• Fingernails
• Grease or chemical spatters
• Wood- and metalworking and any kind of repair work

In all but the most unusual cases, the patient will know exactly what happened and what is likely causing the irritation in the eye.  He will likely report that it feels like there is a grain of sand in the eye.  Speaking as one who has experienced both corneal abrasion and corneal ulcer, it can feel as if that grain of sand is very large. 

When someone has eye pain, the first order of business is to carefully examine eye.  Most of the time, before you ever examine the eye, the offending foreign body will have been removed by the body’s natural reaction of producing tears, though the pain may still remain.  Use a moistened, sterile Q-tip to lift and evert the eyelid to thoroughly examine eye.  Anesthetic drops are helpful but may not always be available, so you may need to fashion a paperclip into a splint to hold the eyelid open.  Make sure that the ends are pointed out and away from the eye.  Use contact lens multi-purpose or saline solution to flush out the foreign object and irrigate the eye.  The most common place for a foreign body to lodge is under the upper eyelid where it can be found by rolling back the lid and looking underneath.[1] 

Once assured there is nothing left in eye, examine the cornea, the clear layer of tissue over the iris. 

After the eye is cleaned out with contact solution if available or clean water if not, use antibiotic drops if available, and cover the closed eye with an eye pad and tape.  While ibuprofen is what is generally offered for pain relief, most doctors will not object to using something stronger if you have it on hand, and indeed, prescription pain medication is sometimes offered for more serious cases.  In an austere situation, sleep is going to be the best remedy.  The eye will heal within a few days. 

Corneal Ulcer

If the cornea has been damaged a bit more than with a simple abrasion, it is called an ulcer.  Careful examination may reveal a grayish or less shiny patch on the cornea surface.  Fluorescein strips will highlight the scratch or abrasion and confirm diagnosis.  The injured area takes up the fluorescein dye and becomes brilliant green.[2] 

Fluorescein strips or drops are quite inexpensive; mine were about $12 at ShopMedVet.com.  You just drag the strip across the eye and the dye will concentrate in the injury.  Then use a blue light pen to illuminate the abrasion or ulcer.  This makes it easier to determine whether the irritant has been removed or the extent of the injury.  While having these strips and the light pen are a good idea for every family, they really should be considered essential items for people who wear contact lenses, as people in this group are at particular risk for corneal abrasions and ulcers. 

A corneal ulcer, if not properly treated, may cause blindness.  A physician will advocate the use of antibiotic eye ointment four times per day for one week. In addition, s/he may prescribe penicillin and advise covering the eye with a patch.[3] 

Most corneal abrasions heal within a few days, with minor scratches being vastly improved within 24 hours.  Corneal ulcers take longer to heal, up to a couple of weeks.  If the eye worsens, thick drainage develops, or vision deteriorates, seek licensed medical attention immediately.  If the patient is a contact lens wearer, s/he should not wear lenses until the eye is fully recovered plus an additional week. 

References:

[1]  The Ship’s Medicine Chest and Medical Aid at Sea, 1978, p 98.

[2]  Ibid.

[3]  David Werner, Where There Is No Doctor, 224. 

Joseph Alton, The Survival Medicine Handbook, 431.

 12.16.20