Corneal Abrasion and Ulcer – Traumatic Injuries

by Richard Mitchell, MD, PhD

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    00:02 Welcome back.

    00:03 This will be a relatively brief stroll through some major traumatic injuries of the eye.

    00:11 Just so that you can be aware of some specifics and think a little bit more about the anatomy and consequences related to being blunt force to getting blunt force trauma of the eye.

    00:28 So, part of this will be the cornea, and some of this will be the orbit or the bones around the eye.

    00:35 The cornea is as you will recall, a stratified squamous non-keratinizing epithelium that sits over a stroma.

    00:46 It is innervated.

    00:48 And because it's an epithelium, we can erode that.

    00:52 We can erode off layers of the epithelium.

    00:55 And or we can completely ulcerated.

    00:57 So those are the major effects that are going to happen in this epithelium.

    01:01 And this can be scraping or any of a variety of injuries of that nature.

    01:06 So, we'll talk about corneal abrasion and ulcers.

    01:09 And just keep in mind that epithelium that you're seeing on the right hand side.

    01:13 So signs and symptoms associated with corneal abrasion, because there is some innervation there.

    01:17 It will be painful, and there will be inflammation, because we have eroded that area, and we will induce a conjunctivitis around that.

    01:30 Because of inflammation, the vessels are leaky, and we'll get watery eyes.

    01:36 The arrow there is actually pointing to an area where we have a superficial erosion and abrasion, where we have scraped off two, or three, or four layers of that stratified squamous non-keratinizing epithelium.

    01:51 Because now we have exposed some raw nerve and in civil feel like there's something in the eye.

    01:56 It would feel very uncomfortable.

    02:00 Because again, of inflammation, and the mediators that are made during inflammation, we will tend to have mydriasis, will tend to have a more dilated pupil, and so that will tend to give you photophobia.

    02:11 And with the edema that's in the eye as a result of the inflammation will tend to have blurred vision.

    02:17 So all these things make sense, once we have an inflammatory response to a superficial abrasion.

    02:23 One of the best ways to visualize how much of the cornea has been abraded by particular contact or rubbing is with the flourescein stain.

    02:31 So, we'll take a dilute fluorescein dye, drop it in by eyedrops.

    02:35 And then with a blue fluorescent lamp, you can actually see it, visualized here is this kind of yellow green area where we have increased dye uptake? And that shows the kind of geography of what portion of the cornea has been abraded? How do we treat this? Well, we don't want that to get infected.

    02:55 We could have as we will see a superficial abrasion turn into an ulceration and maybe something worse.

    03:03 So we'll put topical antibiotics in there.

    03:05 If there's anything retained in the cornea, as a result of the original trauma, we will obviously remove that.

    03:13 We can actually put on a little contact lens.

    03:14 So, it's like putting a band-aid, but over your cornea.

    03:19 It will make it feel better, and will lessen the amount of risk, in terms of secondary infection.

    03:26 And because it hurts, we'll give you oral analgesia.

    03:29 So, that's kind of the make sense in terms of the basic therapy for corneal abrasion.

    03:35 An ulcer is deeper.

    03:37 So, we have now gone all the way through all those layers so that superficial squamous non-keratinizing epithelium, we're down to basement membrane and stroma.

    03:46 So there's going to be greater risk for a variety of things.

    03:49 And they're going to be more symptoms simply because we have scraped away more real estate.

    03:54 So there will be that conjunctivitis associated with the inflammation.

    03:58 It will hurt like the dickens.

    04:00 It is going to be extremely painful.

    04:03 The nervous innervation of the cornea is going to make it really feel like there's something definitely in the eye of foreign body.

    04:10 There will be a discharge. Again, because of the inflammation.

    04:15 There's increased vascular permeability.

    04:17 There'll be a lot more fluid that's coming out.

    04:22 Because of the edema, there will be blurred vision.

    04:24 And again, there'll be photophobia.

    04:27 Because of the inflammation, we tend to get mydriasis.

    04:30 So, we get dilation of the pupil, and there will be sensitivity to light.

    04:37 How can this happen? So, trauma.

    04:40 So, a superficial abrasion with a secondary infection.

    04:43 Bingo.

    04:45 We're down now into a deeper ulcer that gets beyond all the layers of the cornea.

    04:52 Contact wearers who aren't scrupulous about taking their contacts out on a regular basis, and or cleaning their contact lenses can get bacterial and fungal infections that will over time sit underneath the lens and erode all the layers of the stratified squamous epithelium.

    05:13 Some viral infections can do this such as herpes simplex, and the sicca syndrome, the Sjogren syndrome, dry eyes that are associated with diminished lacrimation.

    05:24 Remember that autoimmune diseases.

    05:26 That will actually can lead to corneal drying.

    05:29 And with more corneal drying, there will be a greater predisposition to getting corneal ulcerations.

    05:35 Most important: Once we have an ulcer is that we give topical antibiotics, and of course we'll give analgesia because it hurts like the dickens.

    About the Lecture

    The lecture Corneal Abrasion and Ulcer – Traumatic Injuries by Richard Mitchell, MD, PhD is from the course Trauma and Neoplasms of the Eye.

    Included Quiz Questions

    1. Foreign body sensation in the eye
    2. Purulent discharge from the eye
    3. Inability to open the eye
    4. Inability to close the eyelid
    5. Swelling in the eyelid
    1. Fluorescein staining
    2. Tonometry
    3. Schirmer test
    4. Manometry
    5. Slit-lamp exam
    1. Herpes simplex virus
    2. Varicella-zoster virus
    3. Treponema pallidum
    4. Rubella
    5. Staphylococci
    1. Sjogren's syndrome
    2. Down syndrome
    3. Heerfordt syndrome
    4. Marfan syndrome
    5. Turner syndrome

    Author of lecture Corneal Abrasion and Ulcer – Traumatic Injuries

     Richard Mitchell, MD, PhD

    Richard Mitchell, MD, PhD

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