By Pediatric Ophthalmologist Erin Schotthoefer, MD, Charlotte Eye Ear Nose and Throat Associates
Any parent can understand how much they would love to keep their children from any and all pain and disappointment. Seeing your child injured and hurting is a terrible feeling, and when it comes to eye injuries, parents often feel a sense of helplessness as the injury is often small and difficult to see, and parents may not be able to help their child relieve the pain. It is at times like these, that it is important to call your pediatric ophthalmologist so that he or she can assist your child and treat the injury appropriately. One of the common eye injuries that we see in children is a scratch on their cornea, and my hope today is to explain what a scratched cornea means for your child, and dispel some of your fear if your child ever scratches their cornea.
A scratch on the cornea is called a corneal abrasion. This is similar to a scratch on the skin but it can cause significant pain. This is less serious than a laceration of the cornea which is analogous to a full thickness cut through the skin and is a vision threatening emergency. Corneal abrasions can happen from trauma such as from a fingernail scratch, an injury from a toy, or when something has been thrown or when a patient falls. Children can also get abrasions from foreign bodies such as sticks or when a material, such as sand, blows into the eyes and scratches them. A chemical exposure or splash can also cause corneal abrasion.
Symptoms of a corneal abrasion can be tearing, blurry vision, pain and redness of the eye. Sometimes patients will notice more pain with blinking, or light sensitivity, and symptoms may be improved by keeping the eye closed.
An ophthalmologist examining your child will instill a fluorescein drop in the eye. This is a yellow dye that when viewed with a cobalt-blue light, will stain any corneal abrasion bright green. The size of the abrasion will be documented and the eye examined to make sure that there is no sign of infection developing (a corneal infiltrate) and no other injury to any structures in the eye. If a patient has had more serious trauma with a sharp object (such as an object with a point like a pencil or a knife) or with any object that is travelling at a high rate of speed such as a bungee cord, a paint ball or something that is being hammered, there is a much greater likelihood that the injury is more serious than a corneal abrasion and these injuries can also be vision threatening.
The good news is that while corneal abrasions are very painful, the cornea heals quickly. Most patients will heal within hours to days. The goal of treatment is to improve patient comfort and prevent infection while healing occurs. Patients with corneal abrasions will often be put on antibiotic drops or ointment to try to prevent infection. A special case is patients who wear contact lenses as these children are at significant risk for infection and so any contact lens wearer with a red or painful eye needs to be evaluated as this could be a vision threatening infection called a corneal ulcer.
Patients with corneal abrasions can take ibuprofen and acetaminophen for pain control. Some patients like a cool compress on the eye. Some patients like to use artificial tears to soothe the surface, and we would recommend a new bottle of artificial tears to decrease the risk of infection. Sometimes keeping the eye closed is the most comfortable so that the eyelids are not blinking over the healing cornea and causing pain. In large abrasions, ophthalmologists will sometimes use a pressure patch to insure that the eyelids stay closed over the eye, or will place a special contact lens called a bandage contact lens on the eye to protect it. We would not recommend a patient patching their own eye due to the risk of the eye opening under the patch and worsening the abrasion.
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