Corneal Abrasion in Children

The cornea is a clear layer of tissue covering the front of the eye. It protects the eye from irritants and minor damage. When this tis­sue is scratched or damaged, the result is called a corneal abra­sion.

Anything that swipes across the eye, such as sand, a fingernail, or a piece of paper, plastic, or metal, can cause a corneal abra­sion. Because a corneal abrasion is caused by physical damage, it is not contagious.

A scratch on the cornea usually causes acute pain. Bright lights become uncomfortable, and so a child with a corneal abrasion will likely close her eyes in the daylight or in a well-lit room. Her eye will tear frequently, and she will likely blink more often than usual. The eye may look red and irritated, but it also may look completely normal. In some cases, your child may be in so much pain that it is difficult for you to inspect her eye.

What can I do?

You could patch the eye temporarily using a piece of gauze or other material to make your child more comfortable in bright light. Often, though, the patch is more irritating than soothing, especially a makeshift patch placed by a parent. Therefore, it is better to let a health care provider patch the eye than to attempt to do it yourself.

When does my doctor need to be involved?

Anytime you suspect that the eye has been injured, you should consult your doctor immediately.

What tests need to be done, and what do the results mean?

The entire eye — including the eyeball and the area underneath the-lid — will be checked for tears, scratches, and foreign bodies (such as pieces of sand or glass). Many doctors will use fluores­cein — a fluorescent eyedrop — along with a handheld light, to try to detect any abrasion. The fluorescein lasts for only a few seconds, is harmless, and does not cause any additional pain.

If a health care provider is unable to examine the eye thor­oughly, or if a more detailed exam is necessary, an ophthalmolo­gist (eye doctor) should be called to do an extensive exam. During this slit lamp exam, your child will sit in a chair, resting her chin on a stable surface. The ophthalmologist will be able to see all layers of the eye, from the cornea to the retina in the back of the eye, and can check for various types of injury. Toddlers are generally able to cooperate with slit lamp exams because they do not hurt.

What are the treatments?

If your child’s cornea is scratched, your doctor will likely pre­scribe an antibiotic to prevent a secondary infection. The scratch itself is probably sterile, unless it was caused by a dirty piece of metal or glass. But a broken corneal surface can attract numerous bacteria, complicating the healing of the abrasion. The antibiotic may be in the form of a drop, an ointment, or an oral preparation.

Your doctor may suggest an eye patch to help make the eye more comfortable. The patch will minimize rapid blinking, which in turn will speed the healing of the abrasion. The most important lit of this treatment is to leave the patch in place for as long as directed. If your child removes the patch, she will likely blink more, squint in light, and have more pain because of these automatic responses. All of this movement will delay healing. Patching the eye is controversial because many children, especially toddlers, find it bothersome. But it really can make your child more comfortable. Most patches are used for only 24 hours. The larger the abrasion, the more likely it is that your doctor will suggest a patch.

What are the possible complications?

The cornea typically heals within a few days. However, a deep abrasion may become infected, especially if prophylactic antibi­otics are not used. Abrasions can also scar. Poorly healed corneal abrasions may develop recurrent erosion. Scars and erosions in the eye can cause a range of symptoms, including tearing, mild discomfort, and blurry vision.

In the most extreme cases, the cornea may be so damaged that your child will eventually need a new one. This is accomplished through corneal transplantation. Although this procedure is exceedingly rare, the prospect of needing such surgery highlights the importance of detecting and treating a corneal abrasion.

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