Patient handout

Corneal abrasion & ocular-surface foreign body

PRODUCTION

1. Your condition

This handout is for corneal abrasion & ocular-surface foreign body. Your care team identified this based on: acute unilateral sharp eye pain, foreign-body sensation, tearing and photophobia after trauma/fb (classic simple corneal abrasion — cronau afp 2010; lim cochrane 2016).

Other reasons your team may use this plan: contact-lens wearer with a painful red eye — always treat as possible contact-lens microbial keratitis until excluded (linaburg idcna 2024 — pseudomonas-skewed; never patch); high-velocity mechanism — grinding, hammering metal-on-metal, drilling, lawn-strimmer — intraocular/retained-fb & globe-penetration prior is high (sindal ijo 2017; aao eye trauma); organic / vegetative matter injury (branch, fingernail, plant, soil) — fungal-keratitis and recurrent-erosion risk modifies antibiotic choice & follow-up (linaburg idcna 2024).

2. Your medications

Take these medications exactly as prescribed. Do not stop or change a dose without talking to your provider.

Medication	Starting dose	How	When	What it does
dangerous_lookalike_exclusion_gate	—	—	—	Globe rupture/penetrating injury → SHIELD, never pad/pressure, emergency, route ophtho.ocular-trauma.core.v1. Infiltrate/hypopyon → microbial keratitis, culture, intensive topical, NEVER patch, route ophtho.microbial-keratitis.core.v1. High-velocity → CT orbit (NEVER MRI if metallic) for IOFB. These are NOT treated on the abrasion ladder (AAO Eye Trauma; Linaburg IDCNA 2024).
foreign_body_removal_and_lid_eversion	—	—	—	Slit-lamp FB removal (cotton bud / 25-30G needle bevel-up at slit-lamp), upper-lid eversion + fornix sweep, rust-ring burr for residual metallic ring; a retained FB is the dominant non-healing cause (Cronau AFP 2010).

Plan: Confirmed simple corneal abrasion — prophylaxis + analgesia ladder (NOT for ulcer / penetrating injury / IOFB)

3. When to call your provider

Contact your care team if any of the following happen:

Any red flag (Seidel, infiltrate, peaked pupil, low acuity, contact-lens worsening) → same-day/emergent ophthalmology, route OUT by engine_id (AAO Eye Trauma; Linaburg IDCNA 2024)
Non-healing at 48-72 h → ophthalmology for retained FB / ulcer / erosion (Ross Can J Ophthalmol 2017)

4. When to seek emergency care

Call 911 or go to the nearest emergency room right away if you have:

Seidel-positive fluorescein stream, peaked/teardrop pupil, shallow/flat anterior chamber, uveal prolapse, or low acuity after a sharp/high-velocity mechanism — full-thickness penetration / globe rupture (AAO Eye Trauma; Cronau AFP 2010)(life-threatening)
High-velocity mechanism (grinding, hammering metal-on-metal, drilling, strimmer) with an entry wound, occult low acuity, or vitreous/retinal signs — suspected intraocular/retained foreign body (Sindal IJO 2017)(life-threatening)
Contact-lens-related or organic/vegetative-matter abrasion, OR any abrasion with a stromal infiltrate, anterior-chamber reaction or hypopyon — microbial (esp. Pseudomonas) keratitis risk (Linaburg IDCNA 2024)
Branching dendritic fluorescein staining with terminal end-bulbs, reduced corneal sensation, or recurrent unilateral keratitis — herpes simplex / zoster keratitis, NOT a traumatic abrasion (Cronau AFP 2010)
Persistent/escalating pain with a non-healing ring-shaped stromal infiltrate, especially after access to or self-use of a topical anaesthetic — anaesthetic-abuse toxic keratopathy (Tok Int J Ophthalmol 2015; Shen Indian J Ophthalmol 2020)

5. Follow-up

Recurrent corneal erosion prevention & counselling (the long-tail deliverable): for organic / fingernail / large abrasions or recurrent waking pain → prolonged lubrication, nocturnal hypertonic-saline ointment, consider epithelial debridement / bandage lens / referral (Ross Can J Ophthalmol 2017; Wang Eye Contact Lens 2022). Contact-lens hygiene + lens holiday; occupational eye-protection counselling for grinding/hammering; safe lens re-wear timing.

6. Sources

Guideline: AAO Preferred Practice Pattern — Corneal/External Disease & Ocular Trauma + Lim, Patching for corneal abrasion, Cochrane 2016 + Wakai, Topical NSAID for traumatic corneal abrasion, Cochrane 2017 + Sulewski, Topical ophthalmic anaesthetics for corneal abrasions, Cochrane 2023 + Linaburg, Contact lens-related corneal infections, Infect Dis Clin North Am 2024 + Cronau, Diagnosis and management of red eye in primary care, Am Fam Physician 2010 + Ross, Practice patterns in interdisciplinary management of corneal abrasions, Can J Ophthalmol 2017