About Corneal Abrasions

What is the cornea?

The cornea is the front of the eye that is clear like a window and shaped like a dome over the coloured part of the eye. It has 5 layers, including a very thin superficial layer called the epithelium. This is the layer that can peel off when the eye is scratched.

What happens when there is a corneal abrasion?

When the cornea is scratched, the epithelium or top layer has been peeled off. This causes temporary decreased vision and extreme pain.

How is a corneal abrasion treated?

A simple corneal abrasion is usually patched with a tight patch and antibiotic ointment. If the abrasion has jagged edges, it may be necessary to clean the edges so it can heal properly under the patch. Your ophthalmologist can do this during the office visit. A dilating drop may also be used to decrease light sensitivity. The patch should be removed the next day and the eye should be rechecked by the doctor. If it is not completely healed it may be re-patched and rechecked the next day. Usually, corneal abrasions will heal within 24-48 hours. Sometimes, the abrasion may take longer to heal, especially if they have been caused by an organic substance like a fingernail or a tree branch. In this situation, it is helpful to use a bandage contact lens. Your eye doctor can put this on your eye. You will not need to remove it for a few days. It is like a clear patch that you can see through. You will have to take antibiotic eye drops while wearing this bandage contact lens. If it falls out, you can just leave it out and see your eye doctor in follow-up. This bandage contact lens allows more time for the abrasion to heal. Your eye doctor will monitor your progress and remove the contact lens once the abrasion has healed. There is a risk of developing infection if the contact lens is left on for too long and not monitored. Make sure you keep to your follow-up appointments to ensure proper healing without complications.

Would I be able to see well again after the corneal abrasion is healed?

The short answer is YES. The cornea usually heals very well and you will be back to your normal state in 2-3 days after it has healed completely. However, if you have an infection on top of the scratch, or have delayed healing for various reasons, you may be left with irritation or a scar that might blur your vision (see below).

Why do some corneal abrasions take longer to heal? Will the scratch every come back?

If your corneal abrasion was caused by something organic (something that has carbon in it), like a fingernail, a tree branch or paper, this can cause poor healing especially for adults. These abrasions often take longer to heal and sometimes never heal properly. They may have little cysts under the top (epithelial) layer that can rip off months later when you first open your eyes in the morning. This causes "recurrent corneal erosion" and feels like the first time you got your eye scratched.

To prevent these cysts from forming, you need to use Muro 128® ointment at night for 4-6 months in your affected eye. To apply ointment properly, please refer to the section "How do I apply eye ointment?". This ointment is greasy and has a high level of salt in it. It causes the cysts to shrivel up and allows the top layer of the cornea to stick down properly. Although this ointment is available over the counter, you may have to ask the pharmacist for it.

If you are scratched by a contact lens, this scratch may become infected and may not be suitable for patching (because this may allow the infection to get worse). This type of scratch would have to be treated with frequent antibiotic eye drops and rechecked by your eye doctor regularly until it heals. Your eye doctor will let you know if and when it would be safe to wear contacts again. Wearing contacts again without taking precautions may put you at risk for another infection. If you have an infection that develops into an ulcer, this could lead to scarring and permanent loss of vision. Therefore, it is very important follow the prescribed treatment and listen to your eye doctor's advice.

If you are diabetic, or have any nutritional deficiencies, you also may experience delayed healing of a scratched cornea. Extra vitamin C, good nutrition and hydration and controlled blood sugars would help the healing process.