Corneal Abrasion (Scratched Eye)

What to do right away

If you think you have scratched your eye:

1. Rinse it. Flush the eye with clean water or sterile saline from a cup or eyewash bottle. This may wash out grit that is still causing damage.
2. Blink several times. Pull the upper lid out and down over the lower lid so the lashes brush away loose particles.
3. Do not rub. Rubbing drags any trapped particle across the cornea and makes the scratch larger.
4. Take out contact lenses and do not put them back in.
5. Do not try to remove anything stuck to the eye with tweezers, a cotton swab or a fingernail.
6. Do not use redness-relief drops or old eye drops you have at home.
7. Get the eye examined the same day by an eye doctor, urgent care clinic or ER.

Symptoms of a scratched cornea

The cornea has more pain nerve endings per square millimeter than almost any tissue in the body, so even a tiny scratch hurts a lot. Typical symptoms are:

• sudden sharp or stinging eye pain, often worse with blinking
• a feeling that sand or an eyelash is stuck in the eye, even after it has been rinsed
• heavy tearing and a red eye
• squinting, and pain when you look at bright light (photophobia)
• blurred vision if the scratch is near the center
• a headache or ache around the eye

Symptoms often start immediately after a known injury. They can also appear on waking, when a contact lens has been worn overnight or the lid sticks to a fragile area of cornea.

Common causes

• Fingernails, including a baby's fingernail scratching a parent's eye
• Contact lenses that are torn, worn too long, slept in or put in with a trapped particle
• Foreign bodies such as dust, sand, sawdust or metal flecks, especially when they lodge under the upper eyelid and scratch with each blink
• Plants: branches, leaves and thorns during gardening or hiking
• Makeup brushes and mascara wands
• Sports injuries and paper edges
• Very dry eyes, which make the surface fragile

How doctors diagnose a corneal abrasion

A doctor will ask exactly how the injury happened, because high-speed metal fragments and chemicals change management. They will check your vision in each eye, then:

• put in an anesthetic drop, which stops the pain within seconds and makes the exam possible
• add fluorescein, an orange dye that stains damaged cornea; under a cobalt-blue light the abrasion shows up bright green
• examine the eye under a slit lamp microscope to measure the scratch and look for infection or deeper damage
• flip the upper eyelid to look for a hidden foreign body; a pattern of vertical scratches suggests something trapped under the lid

The numbing drop is not given to take home. Repeated use slows healing and can damage the cornea.

If the history suggests a penetrating injury, the doctor may check for leaking fluid (a positive Seidel test) and arrange a CT scan of the orbit.

Treatment

Medicines

• Antibiotic drops or ointment, such as erythromycin ointment or a fluoroquinolone drop, to prevent infection while the surface heals. Contact lens wearers get an antibiotic that covers Pseudomonas, a bacterium that can cause aggressive ulcers.
• Pain relief: acetaminophen (paracetamol) or ibuprofen by mouth, following the label dose. Some clinicians also prescribe NSAID eye drops for a short time.
• Dilating drops are occasionally used when pain from eye muscle spasm is severe.

Eye patching

Patching was once routine. Studies have shown that it does not speed healing or reduce pain for most abrasions, and it removes depth perception. It is no longer standard, and it should never be used in contact lens wearers or when infection is possible.

Comfort at home

• Wear sunglasses outdoors and dim screens.
• Avoid swimming, dusty work and eye makeup until the eye is fully healed.
• Do not wear contact lenses until a clinician says the cornea has healed and you have finished antibiotics, usually at least a week.
• Use preservative-free lubricating drops for a few weeks after a large abrasion to reduce the risk of recurrence.

How long a corneal abrasion takes to heal

Surface cells slide in from the edges to cover the defect, so pain usually eases noticeably within a day. If pain is getting worse rather than better after 24 hours, or a white spot appears, return the same day.

Complications

• Corneal ulcer: infection of the scratch, most often in contact lens wearers. It needs intensive antibiotic drops and close follow-up. See corneal ulcer.
• Fungal keratitis: after injuries with plant matter. It can appear days later.
• Recurrent corneal erosion: the new surface layer does not anchor firmly and peels off again, typically on waking, weeks or months later. It causes sharp pain on opening the eyes in the morning. Lubricating ointment at night usually helps, and specialist treatments exist for stubborn cases.
• Scarring: rare after simple abrasions, but deep or central injuries can leave a haze that affects vision.

Prevention

• Wear safety glasses for grinding, hammering, drilling, mowing and trimming hedges.
• Keep fingernails short when caring for babies.
• Follow contact lens wearing and replacement schedules, and do not sleep in lenses unless they are approved for it. See contact lens complications.
• Use protective eyewear for racquet sports.

Frequently asked questions

How do I know if I scratched my cornea?

A scratched cornea causes sudden sharp pain, a persistent gritty feeling, watering, redness and sensitivity to light. If the feeling continues after rinsing, the scratch may still be there, or a foreign body in the eye may be trapped under the lid. Only an exam with fluorescein dye can confirm it, so see a doctor the same day.

How long does a corneal abrasion take to heal?

Most small corneal abrasions heal in 24 to 72 hours, and pain is usually much better after the first day. Larger or central scratches can take up to a week. Pain that worsens after 24 hours, discharge or a white spot on the eye suggests infection and needs prompt review.

Can a scratched eye heal on its own?

Very minor scratches often do heal by themselves, because the surface regenerates quickly. However, doctors still recommend an exam and antibiotic drops, because an unnoticed foreign body or an early infection can damage vision. This is especially important for contact lens wearers and injuries from plants or metal.

Should I sleep with a scratched cornea patched?

Usually not. Research shows patching does not speed healing or reduce pain for most corneal abrasions. Many doctors prescribe antibiotic ointment at night instead, which also lubricates the eye. Never patch an eye in a contact lens wearer or if infection is possible.

When can I wear contact lenses again after a corneal abrasion?

Wait until a clinician confirms the cornea has healed, there is no pain or redness, and you have finished any antibiotic course. This is often about a week. Use a fresh pair of lenses and a new case, since the old ones may carry bacteria.

Why does my eye hurt when I wake up weeks after a scratch?

This is typical of recurrent corneal erosion. The healed surface layer sticks to the inside of the eyelid overnight and tears when you open your eyes. Lubricating ointment at bedtime helps many people. See an eye doctor if it keeps happening.