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Eyes & Vision

Corneal Abrasion

A corneal abrasion is a traumatic defect of the corneal epithelium causing severe pain, watering and photophobia; confirm it with fluorescein, exclude a foreign body or open-globe injury, and treat contact-lens-associated abrasions as higher-risk for microbial keratitis.

In a nutshell

A corneal abrasion is a painful epithelial defect after trauma. Confirm with visual acuity, fluorescein under blue light, lid eversion and slit-lamp assessment; exclude open globe, retained foreign body and stromal infiltrate. A clinician may prescribe short-course topical antibiotic and oral analgesia for an uncomplicated abrasion, but contact-lens-associated staining needs urgent eye review for microbial keratitis. Do not send topical anaesthetic home; avoid routine padding and safety-net worsening pain, redness, discharge, blur or failure to improve.

Classic presentation

A patient develops sudden severe pain, watering, photophobia and foreign-body sensation after a fingernail, paper, twig or contact-lens injury; fluorescein shows an epithelial defect without infiltrate.

Key points

  • The densely innervated cornea makes a small epithelial defect very painful.
  • Fluorescein under blue light maps the epithelial defect, but mechanism and slit-lamp findings determine urgency.
  • Evert the upper lid when there is a foreign-body history or vertical linear staining.
  • High-velocity/sharp trauma, distorted pupil, shallow chamber, uveal prolapse or suspected intraocular foreign body is an open-globe emergency.
  • Contact-lens-associated corneal staining needs urgent eye-care assessment because of microbial keratitis risk; do not treat it as routine chloramphenicol-only abrasion.
  • Topical anaesthetic is for examination only, and worsening pain/redness, discharge, blur or non-healing requires reassessment.

First-line investigation

Visual acuity, fluorescein staining with blue light, lid eversion/foreign-body search and slit-lamp/anterior-chamber assessment.

Management

Exclude open globe, keratitis and retained foreign body

  • High-velocity/sharp injury, distorted pupil, shallow chamber, uveal prolapse, infiltrate, discharge, major visual loss or contact-lens staining needs urgent eye assessment; irrigate chemical injury immediately.1,4,5

Confirm with fluorescein and lid eversion

  • Record visual acuity, stain the cornea with fluorescein under blue light, evert the upper lid for a subtarsal foreign body and assess depth/anterior chamber at slit lamp where available.1,4

Treat uncomplicated surface injury

  • Use oral analgesia and clinician-directed short-course topical antimicrobial/lubricant treatment; routine eye padding is unnecessary for many cases and topical anaesthetic must not be supplied for home use.1,2,7

Escalate contact-lens and infected injuries

  • Contact-lens wearers with corneal staining, a white infiltrate, discharge or worsening pain need urgent ophthalmic assessment; do not rely on routine chloramphenicol, and use specialist/local-pathway antimicrobial decisions.4,5,6

Safety-net healing and recurrent erosion

  • Keep lenses out until healed and cleared to restart; seek review for increasing pain/redness, discharge, worsening blur or failure to improve within 24–48 hours. Recurrent pain on waking later suggests recurrent corneal erosion.2,3,8

Exam traps

  • A fluorescein-positive defect does not exclude an intraocular foreign body or open-globe injury.
  • A white infiltrate, discharge or worsening pain suggests microbial keratitis, not a simple abrasion.
  • Never supply topical anaesthetic for repeated home use; it delays healing and masks progression.
  • Contact-lens wearers need urgent eye assessment and must not restart lenses until the eye team/lens practitioner says it is safe.
  • Routine padding is not required for every abrasion; any specialist-selected pad must be avoided when infection risk is present.

Illustrations

Corneal abrasion highlighted by fluoresceinClinical photograph after fluorescein showing a bright green corneal epithelial defect. Label it as an illustrative clinical image and explain that fluorescein findings must be interpreted with mechanism, visual acuity and slit-lamp examination.James Heilman, MD, Wikimedia Commons · CC-BY-SA-3.0

Key sources

  1. College of Optometrists, Clinical Management Guideline: Corneal abrasion (CMG Corneal abrasion, version 15)Updated 9 Dec 2025
  2. Moorfields Eye Hospital, Corneal abrasion: diagnosis and treatment (Moorfields Eye Hospital patient guidance)
  3. Cambridge University Hospitals, Corneal abrasion (CUH patient information, document 102219 version 2)Updated 8 Jan 2026
  4. Moorfields Eye Hospital, Corneal abrasions: common eye condition management (Moorfields GP/common eye condition management pathway)
  5. NHS Cornwall, Cornea referral criteria (Corneal erosion/abrasion and contact-lens-related corneal injury)
  6. NHS Lanarkshire Medicines Guidance, anti-infective eye preparations (Corneal abrasion antibiotic formulary guidance)
  7. BNF, Chloramphenicol (BNF drug monograph: chloramphenicol)
  8. Guy’s and St Thomas’ NHS Foundation Trust, Corneal abrasion (Patient information resource 2223, version 5)

This page is exam revision material, not medical advice, and must not be used for patient care. Always check drug doses against the BNF and current guidance. Full disclaimer.