A corneal scratch or abrasion has several causes, including wearing contact lenses for an extended period, inserting chipped or broken ACL (contact lenses), the presence of a foreign body (such as an eyelash or a grain of sand), a trauma / bump or a liquid that has entered the eye. The cornea performs a double function: it works with other components of the eye such as sclera, tears and eyelids to protect the eyeball and eliminate foreign particles and modifies the light rays that enter the eye helping to focus. Symptoms of a corneal abrasion include tearing, pain and redness of the eye, eyelid spasms, photophobia, blurry vision or foreign body sensation. Fortunately, there are many solutions and remedies to allow the scratched cornea to heal.
Steps
Part 1 of 4: Remove Foreign Bodies
Step 1. Try blinking
Sometimes scratches on the cornea are caused by small debris that get trapped under the eyelid - specks of dust, sand, dirt and even an eyelash. Before you start treating the abrasion, you need to remove the cause. To do this, try blinking consecutively several times. The eyelid movement stimulates the tear glands to produce more fluid which in turn "washes" the eye by expelling the foreign body.
- Pull the upper lid of the affected eye over the lower lid using your right hand. The lower lashes may "brush" the irritant out of the eye.
- Do not try to remove the jammed fragments with your fingers, tweezers or other objects, as you could injure yourself and make the situation worse.
Step 2. Wash your eye
If just blinking didn't bring the desired results, try rinsing the eye with water or saline. The best liquid to use is a sterile or saline solution. Do not use tap water. The ideal solution for an eye wash should have a temperature between 15 and 37.7 ° C and a neutral pH (7.0). Although there are several anecdotes that suggest this remedy, do not wash the eye by pouring the water with a glass or cup, as this could wedge the foreign body further. Follow these instructions to know how and for how long to wash the eye:
- For mildly irritating chemicals, rinse your eye for five minutes;
- If the foreign body is moderately or severely irritating, wash the eyeball for at least 20 minutes;
- For non-penetrating corrosive products, such as acids, continue washing for 20 minutes;
- In the case of penetrating corrosive products such as bases, rinse the eye for at least 60 minutes.
- Take note of any additional symptoms that could indicate the presence of a poisonous solution inside the eye - nausea or vomiting, headache or dizziness, diplopia or visual difficulties, lightheadedness or loss of consciousness, rash or fever. If you show this symptomatic picture, call the poison control center in your region and go to the emergency room immediately.
Step 3. Use artificial tears
Another method of getting rid of objects stuck in the eye is to instill humectant eye drops to wash the eye. It is a product widely available in pharmacies that does not require a doctor's prescription. You can instill it yourself or ask someone to help you. The correct technique for inserting eye drops is described in the third part of this article.
- Artificial tears are designed to lubricate the eyes and keep the surface moist. They are widely available and there are many brands and types. Some products contain preservatives that can irritate the eyes after prolonged use. Preservatives can also cause some discomfort if you instill the humectant eye drops more than four times a day. If you need to use it more often, choose a preservative-free product.
- Hydroxypropylmethylcellulose and carboxymethylcellulose are two common lubricants found in artificial tears and many over-the-counter eye solutions.
- Sometimes the only way to find the right product for your eyes is by trial and error. In some cases it is even necessary to combine several eye drops from different brands. Patients suffering from chronic dry eye should always use wetting products even when their eyes are showing no symptoms. Artificial tears only provide extra help and do not replace natural tearing.
Step 4. If the scratch gets worse and doesn't heal, go to the ophthalmologist
Once the foreign body is removed, the slight scratch should heal on its own within a few days. However, severe abrasions or ones that have become infected need antibacterial eye drops to heal properly. Go to the ophthalmologist if:
- You suspect that the foreign body is still in the eye;
- You experience any combination of these symptoms: blurry vision, redness, severe pain, tearing and extreme photophobia;
- You are concerned that you have a corneal ulcer (an open wound in the cornea) which is usually caused by an infection
- Notice the presence of yellow, green discharge or bloody pus from the eye
- You perceive flashes of light, small dark objects or shadows floating in front of the eye;
- Have you got a fever.
Part 2 of 4: Allowing the Eye to Heal
Step 1. Get a formal diagnosis
If you suspect a corneal injury, you should make an appointment with your ophthalmologist. The doctor will look at the cornea with an ophthalmoscope or a stylus flashlight looking for trauma. He will most likely test you by instilling fluorescein, a dye that makes tears yellow, into the eye. This product allows the ophthalmologist to see the abrasion more clearly in the light.
- Generally, a topical anesthetic is placed in the eye during this exam, then the doctor gently lowers the lower eyelid. Then a strip of fluorescein is placed on the surface of the eyeball and thanks to the blinks the dye will spread throughout the eye. Areas of the ocular surface that become yellow when exposed to normal light indicate the presence of corneal damage. The eye doctor will use a special cobalt blue light to highlight the abrasion and determine the cause.
- A series of different vertical abrasions can be a sign of a foreign body, while branching spots indicate herpetic keratitis. However, several punctate injuries are typically caused by contact lenses.
- The dye may interfere with your vision for some time and you may notice yellow halos for a few minutes. It is normal for yellow liquid to come out of the nose at this stage.
Step 2. Take a pain reliever by mouth to help control the pain
If a corneal ulcer is causing you a lot of pain, it is worth taking an over-the-counter medication to counteract it, for example acetaminophen (Tachipirina).
- Pain management is key, as physical suffering causes stress, which in turn prevents the body from healing quickly and effectively.
- Always take pain medication according to the instructions described in the leaflet and never exceed the recommended dose.
Step 3. Do not put a patch or eye patch on
In the past, these dressings were used to help the eye heal after an abrasion; however, recent clinical studies have shown that their presence increases pain and prolongs recovery times. The eye patch prevents physiological blinking by straining the eyelids and causing pain. They also trigger profuse tearing, create the ideal environment for bacteria to proliferate and delay recovery.
Eye patches decrease the oxygen supply to the eye and the cornea is highly dependent on the oxygenation it receives from the environment
Step 4. Learn about alternatives to eye patches and patches
Currently, eye doctors are more likely to prescribe non-steroidal anti-inflammatory eye drops in combination with therapeutic soft contact lenses. Eye drops help reduce corneal sensitivity and contact lenses act as protection by speeding up the healing process and reducing related pain. Unlike patches, this therapeutic approach allows you to see with both eyes while reducing inflammation. The most used ointments and eye drops contain both topical NSAIDs (non-steroidal anti-inflammatory drugs) and antibiotics.
- Topical NSAIDs: Try diclofenac (Voltaren) 0.1%. Put one drop into the injured eye four times a day. You can also use ketorolac (Acular) in 0.5% solution by putting one drop four times a day. To learn how to instill eye drops, read the third part of this tutorial. Remember to always follow the instructions and dosage on the drug package.
- Topical antibiotics: Use bacitracin in ophthalmic ointment by inserting a 1.3 cm strip two to four times a day. You can also try 1% chloramphenicol (in both eye drops and ointment) and instill two drops every three hours. Another solution is ciprofloxacin in 0.3% solution, the dosage of which changes during the course of treatment. During the first day of treatment you will need to insert two drops every 15 minutes for a total of six hours and then switch to two drops every 30 minutes for the rest of the day. On the second day, you need to instill two drops every hour; from the third to the fourteenth day you can put two drops every four hours. Always follow the dosage indicated on the leaflet.
Step 5. Don't wear make-up
Applying eye makeup, such as mascara or eyeliner, further irritates the injured eye and delays healing. For this reason, you must avoid makeup until the abrasion has completely resolved.
Step 6. Put on your sunglasses
It is worth using them while you are treating the scratched cornea, to protect the eye and limit sensitivity to light. Corneal abrasions sometimes cause photophobia, but you can limit this uncomfortable feeling by wearing UV-protective sunglasses even when you are indoors.
If you experience extreme sensitivity to light or eyelid spasms, your eye doctor may also decide to prescribe eye drops that dilate the pupil. This reduces pain and relaxes the eye muscles. Again, read the third part of the article to learn how to instill mydriatic eye drops
Step 7. Don't wear contact lenses (LAC)
Do not wear them until your eye doctor confirms that you can do it safely. If you typically only rely on this optical correction, you should avoid it for at least a week after the abrasion has formed or until the cornea has completely healed.
- This detail is particularly important if the abrasion was caused by the ACLs.
- You shouldn't wear contact lenses while applying the antibiotic in the eye. Wait at least 24 hours after the last dose of medication before inserting them again.
Part 3 of 4: Using the eye drops
Step 1. Wash your hands
Cleanse them carefully using antibacterial soap, before instilling the eye drops. It is very important to avoid introducing bacteria into the injured eye, otherwise an infection could develop.
Step 2. Open the bottle
Once opened, throw the first drop of liquid. This prevents any debris or dust on the dropper tip from getting into the eye.
Step 3. Tilt your head back and hold a tissue under the affected eye
The handkerchief will absorb the excess fluid that will come out of the eye. It is best to tilt your head back to take advantage of gravity so that the drug penetrates the entire ocular surface rather than exiting right away.
You can instill the drops while standing, sitting or lying down; the important thing is that the head is tilted back
Step 4. Put on the eye drops
Look up and use the index finger of the non-dominant hand to pull down the lower lid of the injured eye. Drop the drug into the conjunctival sac of the lower eyelid.
- As for the number of drops to administer, follow the directions on the package or those provided by the ophthalmologist. Do not exceed the recommended dose.
- If you need to instill more than one drop, wait a few minutes between them to make sure the first has been completely absorbed and is not "washed away" by the next.
- Make sure that the tip of the dropper never comes into direct contact with the eyeball, eyelid or eyelash as you could contaminate the eye.
Step 5. Close your eye
Once the drug is in it, gently close your eyelids for thirty seconds. You can keep your eye closed for up to two minutes. In this way you allow the active ingredient to spread inside the eyelid preventing it from coming out.
Just remember not to squeeze your eyelids too hard, otherwise you will push the drug out of the eye and damage the eye
Step 6. Blot the surrounding area
Use a soft cloth or tissue and gently pat the closed eye to absorb excess liquid.
Part 4 of 4: Avoid Corneal Abrasion
Step 1. Wear a face mask during specific activities
Unfortunately, when you first suffer from corneal abrasion, there is a greater chance of getting injured again. For this reason it is important to take all necessary precautions to protect the eyeballs from foreign bodies and injuries. For example, some studies have shown that wearing safety glasses reduces the risk of injury at work by 90%. Consider wearing a mask or at least safety glasses when doing these activities:
- Playing sports such as softball, paintball, lacrosse, hockey and racquetball.
- Working with chemicals, electrical tools or any other material that could splash in your eyes.
- Mow the lawn and weed.
- Drive a convertible car, motorcycle or bike.
Step 2. Do not wear contact lenses for extended periods
This way the eyes dry out more easily and are therefore more prone to injury. You should only use LACs for the maximum time recommended by your eye doctor.
Plan your day so you don't have to keep LACs all day. For example, if you go for a run in the morning and you know you will want to go out on your bike in the evening, then wear your glasses between these two activities, for example while working on your computer. Make a conscious effort to always carry your glasses with you and replace them for contact lenses when the time comes
Step 3. Use artificial tears to keep your eyes hydrated
Moisturizing eye drops can also be instilled after the abrasion has resolved. This way you not only lubricate the ocular surface, but "wash away" any foreign body (such as an eyelash) before it can scratch the cornea.
