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Erosion of the cornea: causes, symptoms, diagnosis, treatment
Last reviewed: 18.10.2021
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Erosion of the cornea is a self-limiting, superficial epithelial defect.
The most typical damage to the conjunctiva and the cornea is foreign bodies and erosion. Injury of the cornea is possible with improper use of contact lenses. Superficial foreign bodies are often spontaneously removed from the cornea by tears, sometimes leaving residual erosion. Other foreign bodies remain on the surface or in the thickness of the eye. Penetration into the eye is possible as a result of an apparent minimal injury, especially foreign bodies from high-speed mechanisms (eg drill, saw), after hitting or exploding. Infection with corneal injury occurs rarely.
[Symptoms and Diagnosis of Corneal Erosion
Symptoms of erosion or the presence of a foreign body include pain, lacrimation, redness, and secretion. Vision is impaired rarely (in the absence of rupture).
After instillation of anesthetic (for example, 2 drops of 0.5% proparacaine) on the conjunctiva, each eyelid is turned and all conjunctiva and cornea are examined under a magnifying glass or slit lamp. With fluorescence with cobalt lamp illumination, erosion areas and nonmetallic foreign bodies are more distinct. Patients with a high risk of intraocular damage or (significantly less often) with visible perforation of the eyeball need to perform CT to detect intraocular foreign bodies.
Where does it hurt?
What do need to examine?
Treatment of corneal erosion
After instillation of the anesthetic into the conjunctiva, the foreign bodies of the conjunctiva are removed by irrigation or using a moist sterile tissue. Foreign bodies of the cornea, which are not displaced by irrigation, can be removed with a sterile crochet or a thin injection needle 25 or 27G by a sub-shell or a slit lamp. Steel or iron foreign bodies that have remained in the cornea for more than a few hours can leave behind rust fragments, which must also be carefully removed under the slit lamp by scraping or using a low-speed rotor borer.
For all erosions, ointments with antibiotics are used (for example, bacitracin, polymyxin B or fluoroquinolones 4 times a day for 3-5 days). Patients who use contact lenses, with corneal erosion, are prescribed antibiotics with antipseudomonas activity (for example, 0.3% ciprofloxacin ointment 4 times a day). For large erosions (an area larger than 10 mm 2 ) accompanied by symptoms (pain, etc.), the pupil is dilated with the introduction of short-acting cycloplegic drugs (1 drop of 1% cyclopentolate or 5% gomatropine methyl bromide). The eye patch is usually not used, especially with erosion contact lenses and objects contaminated by soil and vegetation. To alleviate discomfort, NSAIDs, such as 0.5% ketorolac solution 4 times a day for 1-2 weeks, can be metnally prescribed. Ophthalmic glucocorticoids are contraindicated, since they can provoke the growth of fungi and herpes simplex virus.
The epithelium of the cornea regenerates quickly, even large erosions heal within 1-3 days. Contact lenses can not be used for 7-14 days. Inspection of an ophthalmologist 1-2 days after the injury is mandatory, especially if the foreign body was removed.
Intraocular foreign bodies require immediate surgical treatment, which should be performed by an ophthalmologist. Before the operation, the pupil is often dilated with 1 drop of 1% cyclopentolate solution or 2.5% phenylephrine solution, which allows to examine the lens, vitreous and retina. Systemic and topical antibiotics are indicated, for example, gentamicin at a dose of 1 mg / kg intravenously with an interval of 8 hours (with normal kidney function) in combination with cefazolin 1 g every 6 hours and 0.3% gentamicin for the eye, 1 drop every hour. When injuring the eyeball, ointments should be avoided. To prevent accidental pressure, which can cause leakage through the wound of the contents of the eyeball, apply protective plates (such as an aluminum plate or the bottom of the paper cups), fixing them over the eyes with adhesive plaster.