Friday, March 5, 2010

Corneal Abrasions and Scratched Corneas

Corneal abrasions and scratched corneas can be extremely painful. The reason that they are so painful is that there are nerves just under the surface of the cornea that become sensitized once the top layer of the cornea (called the epithelium) is removed. These cells on the top of the cornea are very soft and pliable and the layer is very thin. They can easily be removed by a sharp object rubbing across the cornea. This can be anything from a fingernail to the edge of a piece of paper or even the leaf of a tree or bush.

When a patient scratches or abrades the cornea, this becomes an event that the individual has to pay attention to due to the pain involved. While corneal abrasions heal very quickly under most situations (the cornea is the fastest healing tissue in the body) care has to be taken to make sure that an infection does not develop. Once the epithelium is disturbed, the cornea becomes subject to infection. The epithelium presents a barrier to bacteria and other agents that can harm the eye. Eye doctors normally protect the eye from infection by prescribing an antibiotic eyedrop to protect the eye while the cornea heals.

There are different types of abrasions that can affect the cornea. If the cause of the abrasion is something like a fingernail or mascara brush that scratches but does not embed itself into the cornea, the treatment is usually an antibiotic eyedrop and a pain control medication. If the cause of the abrasion involves something that becomes embedded in the cornea, the treatment is different as the embedded object needs to be removed. Removal involves the administration of an anesthetic eye drop and the removal of the object. If the object is on the surface the removal is relatively easy. If the object penetrates the cornea deeply this becomes a much more complicated procedure. Occasionally a metal foreign body will embed in the cornea and leave "rust" residue. The object has to be removed and sometimes the rust must be removed as well.

For large corneal abrasions where the area of the abrasion is clean of debris, a soft contact lens can be placed on the cornea to help with the healing. The soft lens is used in a theratputic fashion in this case. The soft lens becomes a "bandage" for the cornea allowing the epithelium to fill in the area of the damaged cornea and allowing the patient to be much more comfortable during the healing process.

The location of the abrasion is important as well. If the abrasion involves the area over the pupil, care must be taken to not damage the tissue as this can have a permanent effect upon vision. Surface abrasions are easily dealt with in this case, but penetrating abrasions can present a problem and permanently alter vision if the penetration is deep enough to cause a scar to the corneal area over the pupil.

The bottom line is to immediately contact your eye doctor if there is an abrasion to the cornea. While painful, the treatment is often pretty straight forward and the outcome is excellent. In the event of a more serious abrasion, the eye doctor can take the necessary steps to make sure the outcome is as good as can be expected.

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