Corneal Abrasion, Exposure Keratopathy, Ulceration

Background 

  • Corneal abrasion = corneal epithelial defect (KED): An area of missing corneal epithelium. This is akin to a scratch on the skin. Most common causes include trauma, excessive surface dryness, infection, and neurotrophic disease
  • Exposure keratopathy: Development of corneal epithelial defects secondary to incomplete closure of the eyelids (e.g. prolonged exposure of the cornea to air). Most often occurs in pts who are intubated/sedated, have poor orbicularis tone/paralysis (Bell palsy), or have abnormal blink rate (e.g. Parkinson’s)
  • Corneal ulceration: The injury extends past the corneal epithelium and ‘ulcerates’ into the underlying stroma. Ulcerations are often infectious and develop after untreated abrasions (abrasions are essentially open wounds). In rare cases ulcerations can also be sterile (autoimmune/inflammatory).

Presentation and Evaluation 

  • Symptoms include eye pain, redness, tearing, photophobia, blurred vision 
  • Ulcerations commonly also have a white-colored corneal infiltrate. May have mucous discharge, tearing, and severe bonjunctival injection. 
  • 1 drop of Proparacaine 0.5% will improve pain 
  • Note: Proparacaine is used only for diagnostic, and not therapeutic, purposes. Do not administer proparacaine on a scheduled or PRN basis for pain. The duration of action is only 15 minutes, and repeated chronic use can lead to corneal melt/ulceration 
  • 1 drop of fluorescein followed by shining a blue light (or Wood’s lamp) will reveal the KED

Management 

  • VUMC Perioperative Corneal Abrasion Protocol
    • If patient is recently postop or underwent recent extubation and presents with eye pain/burning, blurry vision, redness, photophobia, VUMC has a perioperative corneal abrasion protocol (does not require ophthalmology consult)
      • Erythromycin ophthalmic ointment TID into the lower fornix of eye x5 days
      • If the pain and redness do not improve within 48 hours, then consult ophthalmology
  • Corneal abrasion
    • Can try erythromycin ophthalmic ointment TID as above
    • If the pain and redness do not improve within 48 hours, or have other concerns, consult Ophthalmology
  • Exposure keratopathy
    • If pt is intubated and sedated, or cannot otherwise fully close his/her eyes, take the following measures to prevent development of corneal abrasion or ulceration:
      • Moisture chambers (aka bubble shields) to eyes at all times
      • Copious amount of lubricating ophthalmic ointment (e.g., Lubrifresh) in eyes QID
  • Corneal ulceration
    • If you see whitish material in the cornea itself, this is likely a corneal ulceration and warrants an Ophthalmology consult
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