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Corneal erosion: causes, symptoms, diagnosis, treatment

 
, medical expert
Last reviewed: 07.07.2025
 
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Corneal erosion is a self-limiting, superficial epithelial defect.

The most common conjunctival and corneal injuries are foreign bodies and erosions. Corneal trauma may occur 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 eye. Penetration into the eye may occur as a result of seemingly minimal trauma, especially with foreign bodies from high-speed machinery (e.g., drills, saws), hammer blows, or explosions. Infection with corneal trauma is rare.

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Symptoms and diagnosis of corneal erosion

Symptoms of erosion or foreign body include pain, lacrimation, redness, and discharge. Vision is rarely affected (unless there is a rupture).

After instillation of an anesthetic (e.g., 2 drops of 0.5% proparacaine) into the conjunctiva, each eyelid is everted and the entire conjunctiva and cornea are examined under a magnifying glass or slit lamp. With cobalt-lamp fluorescence, areas of erosion and nonmetallic foreign bodies are more visible. Patients at high risk for intraocular injury or (much less commonly) with visible perforation of the globe require CT to detect intraocular foreign bodies.

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Treatment of corneal erosion

After instillation of the anesthetic into the conjunctiva, conjunctival foreign bodies are removed by irrigation or with a moist sterile drape. Corneal foreign bodies that are not dislodged by irrigation may be removed with a sterile hook or a fine 25 or 27G injection needle with a magnifying glass or slit lamp. Steel or iron foreign bodies that remain in the cornea for more than a few hours may leave behind rust fragments that must also be carefully removed under a slit lamp by scraping or with a low-speed rotary burr.

For all erosions, antibiotic ointments are used (e.g., bacitracin, polymyxin B, or fluoroquinolones 4 times a day for 3-5 days). Patients wearing contact lenses with corneal erosions are prescribed antibiotics with antipseudomonal activity (e.g., 0.3% ciprofloxacin ointment 4 times a day). For large erosions (area over 10 mm 2 ) accompanied by symptoms (pain, etc.), the pupil is dilated by administering short-acting cycloplegic drugs (1 drop of 1% cyclopentolate or 5% homatropine methyl bromide). Eye patches are usually not used, especially for erosions caused by contact lenses and objects contaminated with soil and vegetation. To alleviate discomfort, NSAIDs such as 0.5% ketorolac solution 4 times daily for 1-2 weeks may be prescribed locally. Ocular glucocorticoids are contraindicated because they may promote the growth of fungi and herpes simplex virus.

The corneal epithelium regenerates quickly, even large erosions heal within 1-3 days. Contact lenses cannot be used for 7-14 days. An ophthalmologist examination 1-2 days after the injury is mandatory, especially if a foreign body was removed.

Intraocular foreign bodies require immediate surgical treatment by an ophthalmologist. Before surgery, the pupil is often dilated with 1 drop of 1% cyclopentolate or 2.5% phenylephrine to allow examination of the lens, vitreous, and retina. Systemic and topical antibiotics are indicated, such as gentamicin 1 mg/kg intravenously every 8 hours (with normal renal function) in combination with cefazolin 1 g every 6 hours and 0.3% gentamicin ophthalmic solution 1 drop every hour. If the eyeball is injured, ointments should be avoided. To avoid accidental pressure, which may cause the contents of the eyeball to leak out through the wound, protective plates (such as an aluminum plate or the bottom of a paper cup) are applied and fixed over the eyes with adhesive tape.

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