Pediatric emergency medicine trisk 3684 3684

facilitate corneal and conjunctival healing.

Clinical Considerations
Clinical Recognition
Corneal or conjunctival abrasions may occur even from mild surface trauma,
including accidental self-inflicted injuries. Corneal abrasion can be painful and
accompanied by dramatic photophobia and resistance to opening of the eyes.
Patients may complain of a foreign-body sensation even though no foreign body
is present. In the absence of clinical findings associated with other more severe
injuries and in association with a mechanism of injury that may lead to a
scratching of the cornea, abrasion should be suspected in a painful, red eye. In
newborns who have unexplained fussiness, corneal abrasion is common, as young
infants do not yet have sufficient motor control to avoid scratching the eye
surface.
Triage Considerations
Patients with severe eye pain and redness should be promptly triaged and
assessed. Pain control is a primary concern. Analgesics should be initiated in all
cases.
Management
Literature suggests that patching corneal abrasions does not accelerate healing or
decrease pain. Many physicians suggest applying a lubricating antibiotic ointment
(e.g., bacitracin, erythromycin, Polysporin) three times daily for 3 to 5 days to the
ocular surface without a patch. Topical nonsteroidal anti-inflammatory agents are
used for pain control in adults, but are rarely used for children. There is a
theoretical risk of corneal melting with these agents. For patients who are
relatively asymptomatic with corneal or conjunctival abrasions that are small and
do not involve the pupillary axis (i.e., not involving the central cornea over the
pupil), management with antibiotic or artificial tears alone may be sufficient. The
use of mydriatic drops such as cyclopentolate 1% can be instilled to relieve
ciliary spasm, though this is uncommon. Ointments containing steroids or
neomycin should not be used. If the patient is asymptomatic within 48 hours, no

follow-up is required. Larger corneal abrasions and those involving the pupillary
axis should be seen on the day following the injury by an ophthalmologist. For
any size corneal abrasion, if pain or foreign-body sensation continues for more
than 2 days, or if there is increasing pain and redness, the patient should be
instructed to seek ophthalmologic care.