Corneal Abrasion: Symptoms, Types, Causes and Treatment

Corneal abrasion is one of the most common eye injuries, and while it may sound minor, the symptoms can be intensely uncomfortable and even lead to serious complications if left untreated. Whether caused by a fingernail scratch, a flying wood chip, or an unexpected brush with a contact lens, corneal abrasions demand prompt recognition and proper care. In this article, we’ll explore the symptoms, types, causes, and treatment options for corneal abrasions, drawing on the latest research and clinical best practices.

Symptoms of Corneal Abrasion

Corneal abrasions often make themselves known with sudden discomfort—sometimes so intense that it is impossible to ignore. Recognizing the symptoms early can help prevent complications and ensure effective treatment.

Symptom	Description	Additional Notes	Source
Pain	Sharp, sudden, or persistent	Worsened by blinking or light	1 3 5 7
Photophobia	Sensitivity to light	May avoid bright environments	1 3 5
Tearing	Excessive lacrimation	May be mistaken for crying	1 3 5
Foreign Body Sensation	Feeling of “something in the eye”	Gritty, irritating	1 3 5
Grittiness	Rough, sandy sensation	Similar to foreign body feeling	1 3 5
Blurred Vision	Decreased clarity	Usually mild and temporary	5 10
Redness	Conjunctival injection	Less prominent than pain	3 5
Dry Eye	Dryness, discomfort	Can be delayed after injury	2

Table 1: Key Symptoms

Understanding the Symptoms

Most patients with a corneal abrasion report a sudden onset of pain, which can be severe enough to disrupt daily activities. This pain is typically localized to the affected eye and may worsen with blinking, as the eyelid moves over the exposed corneal nerves 1 3.

Photophobia—or light sensitivity—is another hallmark symptom. Even mild abrasions can make bright lights feel intolerable, prompting individuals to seek dimmer environments 1 3 5. Tearing is common, as the body attempts to flush out any potential irritants and soothe the injured surface.

A foreign body sensation is frequently described, even when nothing is actually present in the eye. Patients may explain it as a gritty or sandy feeling that persists regardless of blinking or rinsing 1 3 5. While blurred vision can occur, it’s usually mild and improves as the abrasion heals 5 10.

Interestingly, delayed dry eye symptoms can develop days after the initial injury, related to changes in corneal nerve signaling and tear production 2. This underlines the importance of monitoring symptoms even after the acute pain subsides.

Types of Corneal Abrasion

Not all corneal abrasions are created equal. Differences in the cause, depth, and associated risk factors can influence both management and prognosis.

Type	Description	Risk/Consideration	Source
Traumatic	Due to direct mechanical injury	Most common; usually superficial	1 3 7 10
Contact Lens-Related	Linked to contact lens use	Higher infection risk	3 5 10
Foreign Body-Related	Caused by embedded or removed objects	May require removal, risk of rust	10
Iatrogenic	Caused by medical procedures	E.g., eye probes, surgery	8 10
Perioperative	Occurs around surgeries (not eye-specific)	Often from eyelid lagophthalmos	8 9 11
Recurrent Erosion Syndrome	Spontaneous reopening of old abrasion	Chronic or recurring	5
Ultraviolet Keratitis	Due to UV light exposure	“Welder’s flash”, sunlamps	5

Table 2: Types of Corneal Abrasion

Overview of the Main Types

Traumatic Abrasions

These are the most frequently encountered and result from direct injury—such as scratches from fingernails, tree branches, or debris 1 3 7 10. Most traumatic abrasions are superficial but can be intensely painful.

Contact Lens-Related Abrasions

Contact lens wearers face unique risks. Abrasions can occur from improper lens use, overwearing, or inserting/removing lenses incorrectly. These wounds have a higher risk of infection, particularly from Pseudomonas bacteria 3 5 10.

Foreign Body-Related Abrasions

Abrasions can occur when a foreign object—like metal or wood—is embedded in or removed from the cornea. In some cases, the object may leave behind fragments or rust, requiring careful removal 10.

Iatrogenic and Perioperative Abrasions

Medical procedures such as ocular measurements or anesthesia (when eyelids are not properly closed) can inadvertently cause corneal abrasions 8 10 11. During non-ocular surgery, failure to protect the eye can result in drying and injury 8 9.

Recurrent Erosion Syndrome and UV Keratitis

Some patients develop recurrent erosions, where an old abrasion site reopens, often during sleep. UV keratitis, or “welder’s flash,” results from intense ultraviolet exposure and causes widespread superficial abrasions 5.

Causes of Corneal Abrasion

Understanding what leads to corneal abrasions is vital for both prevention and appropriate management. These injuries can result from a wide range of everyday activities and medical circumstances.

Cause	Example or Mechanism	Notable Details	Source
Mechanical Trauma	Fingernail, tree branch, makeup brush	Most common cause	1 3 10
Foreign Body	Metal, wood, dust, sand	May lodge or scratch cornea	10
Contact Lenses	Overwear, improper hygiene	Infection risk	3 5 10
Iatrogenic Injury	Medical instruments, eye surgery	A-scan probes, anesthesia	8 10 11
Chemical Injury	Accidental splash, perioperative	Can also damage cornea	9
Incomplete Lid Closure	Lagophthalmos during anesthesia	Leads to corneal drying	8 9
UV Exposure	Sunlamps, welding, outdoor sports	Ultraviolet keratitis	5
Self-inflicted	Rubbing eye, removing dressing	Especially after procedures	11

Table 3: Common Causes of Corneal Abrasion

Diving Deeper into the Causes

Everyday Mechanical Injuries

The vast majority of corneal abrasions are due to mechanical trauma—fingernails, tree branches, paper, or even pets’ claws can all inflict surface injuries 1 3 10. Due to the limited reaction speed of the eyelid, not all threats can be avoided in time 10.

Foreign Bodies

Small objects, especially in industrial or construction settings, may become lodged in the eye or scratch the cornea on removal. Metal fragments can even leave rust rings, further complicating healing 10.

Contact Lenses

Abuse or improper use of contact lenses is a notorious culprit. Sleeping in lenses, poor hygiene, or using damaged lenses can all cause abrasions and greatly increase the risk of infection 3 5 10.

Iatrogenic and Perioperative Causes

Medical examinations, surgical procedures, or even pulse oximeter probe placement (if the patient rubs their eyes post-anesthesia) have been documented to cause abrasions. Prolonged surgery under anesthesia can lead to lagophthalmos, where the eye remains partially open, allowing the cornea to dry and become injured 8 9 10 11.

UV and Chemical Injuries

Exposure to ultraviolet light from welding, sunlamps, or tanning beds can cause widespread superficial injury (UV keratitis) 5. Chemical splashes, though less common, can also damage the corneal surface 9.

Self-inflicted Injury

Patients, especially those emerging from anesthesia, may inadvertently rub their eyes or disrupt dressings, resulting in abrasions 11.

Treatment of Corneal Abrasion

Timely and appropriate treatment is essential for relieving symptoms, promoting healing, and preventing complications like infection or vision loss. Advances in research continue to shape best practices for managing corneal abrasions.

Treatment	Purpose/Use	Current Evidence & Notes	Source
Foreign Body Removal	Eliminate debris	Always indicated if present	1 3 10
Topical Antibiotics	Prevent infection	Standard for most abrasions; adjust for contact lenses	1 3 5 7 10
Pain Control	Relieve discomfort	NSAIDs, oral analgesics, sometimes topical anesthetics	1 3 4 5 16
Patching	Historically used to promote healing	Not recommended for simple abrasions	1 3 12 14 15
Mydriatics/Cycloplegics	Relieve ciliary spasm	Not routinely beneficial for simple cases	1 3 5
Bandage Contact Lens	Protection, pain control	May be used in selected cases	5 14
Lubrication	Prevent dryness	Especially important perioperatively	9
Ophthalmology Referral	For severe/complicated cases	Worsening symptoms, infection, vision loss	3 7 10

Table 4: Treatment Approaches for Corneal Abrasion

Key Principles of Management

Foreign Body Removal and Infection Prevention

If a foreign body is present, it should be carefully removed to prevent ongoing damage 1 3 10. Topical antibiotics are commonly prescribed to prevent secondary bacterial infection. For contact lens-related abrasions, antibiotics effective against Pseudomonas (e.g., fluoroquinolones) are preferred 3 5 10.

Pain Management

Pain control is central to patient comfort. Topical nonsteroidal anti-inflammatory drugs (NSAIDs) and oral analgesics are both effective 1 3 4. Some studies suggest that dilute topical anesthetics may be safe for short-term use, but their long-term safety outside of clinical settings is still debated 16. Cycloplegics (mydriatics) are not routinely recommended for uncomplicated abrasions 1 3 5.

Patching: No Longer Recommended

Once a mainstay of treatment, eye patching has not been shown to improve healing or reduce pain in simple corneal abrasions. In fact, patching may slightly delay healing and result in loss of binocular vision 1 3 12 14 15. The current consensus is to avoid patching for routine cases.

Bandage Contact Lenses and Lubrication

Bandage contact lenses can be helpful in select cases, especially for large or very painful abrasions, but carry infection risks and should be used with caution and under specialist guidance 5 14. Generous lubrication (e.g., ointments, gels) is especially important for perioperative cases to prevent dryness and facilitate healing 9.

When to Refer

Referral to an ophthalmologist is indicated if:

• symptoms worsen or fail to improve in 24-48 hours,
• there’s evidence of infection (discharge, corneal infiltrate),
• vision is significantly impaired,
• or there is suspicion of a penetrating injury 3 7 10.

Prevention

Protective eyewear is a simple and effective measure to prevent many traumatic abrasions, especially in high-risk environments. For surgical patients, taping eyelids closed and using ocular lubricants are standard preventive steps 1 8 9.

Conclusion

Corneal abrasions are common, often painful, but typically heal well with proper care. Understanding the symptoms, recognizing the different types and causes, and knowing current evidence-based treatments are key to effective management and prevention.

Key Takeaways:

• Symptoms include pain, photophobia, tearing, foreign body sensation, and sometimes blurred vision or dry eye 1 2 3 5 10.
• Types range from traumatic and contact lens-related to perioperative and recurrent erosions 3 5 8 9 10.
• Causes include mechanical trauma, foreign bodies, contact lenses, medical procedures, anesthesia-related dryness, UV exposure, and self-inflicted injuries 1 3 5 8 9 10 11.
• Treatment focuses on pain relief, infection prevention (with topical antibiotics), foreign body removal, and avoiding patching for simple abrasions. Most heal within a few days; referral is needed for complications 1 3 4 12 14 15 16.
• Prevention through protective eyewear and perioperative eye care can dramatically reduce risk 1 8 9.

Prompt recognition and tailored management are critical for optimal recovery and vision preservation. If you suspect a corneal abrasion, seek timely medical attention—your eyes will thank you!