Scratches in the eye

𝘌𝘱𝘪𝘥𝘦𝘧𝘦𝘤𝘵 ⁣ ⁣ Focal areas of loss of epithelial layer of the cornea ⁣

𝐂𝐚𝐮𝐬𝐞𝐬:⁣

● Mechanical trauma (eg. fingernail scratch, foreign body, contact lens)⁣

● Exposure (eg. Bell’s palsy, lagophthalmos, proptosis/ exophthalmos)⁣

● Corneal dryness - Decreased tear production (eg. Sjogren’s syndrome, Vit A deficiency)⁣

● Limbal stem cell deficiency (eg. Chemical burns, Ocular surgery, Chronic contact lens⁣ wear, Autoimmune diseases)⁣

● Topical anaesthetic abuse⁣

● Ulcers/ infection⁣

● Neurotrophic Keratopathy (eg. Damage to the trigeminal nerve by HSV/HZV, Diabetes)⁣ ⁣

𝐒𝐲𝐦𝐩𝐭𝐨𝐦𝐬:​

Pain, tearing, foreign body sensation, reduced vision if present in the visual axis⁣ ⁣

𝐃𝐢𝐚𝐠𝐧𝐨𝐬𝐢𝐬 𝐛𝐲 𝐒𝐥𝐢𝐭 𝐥𝐚𝐦𝐩 𝐞𝐱𝐚𝐦𝐢𝐧𝐚𝐭𝐢𝐨𝐧:⁣ ⁣

Instillation of fluorescein dye → visualise with cobalt blue filter → fluorescein does not stain intact corneal epithelium → stains corneal stroma → demarcates area of epithelial loss⁣ ⁣ ⁣

Fingernail scratch- thin, linear defect⁣

Chemical burn- whole corneal surface⁣

Lid abnormalities/ lagophthalmos- inferior corneal defects⁣ ⁣

𝐌𝐚𝐧𝐚𝐠𝐞𝐦𝐞𝐧𝐭:⁣

Frequent lubrication + topical antibiotics

Bandage contact lenses⁣

Pressure patching⁣ ⁣

Image from Rajan Eye Care Hospital

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