Pemicu 5

William T
Blok Penginderaan
 Corneal abrasion
• A corneal abrasion is a defect in the surface of the
cornea that is limited to the most superficial layer, the
epithelium, and does not penetrate the Bowman
membrane.
• In some cases, the bulbar conjunctiva is also involved.
• Corneal abrasions result from physical or chemical
trauma.
• Severe corneal injuries can also involve the deeper,
thicker stromal layer; in this situation, the term partial-
thickness corneal laceration may be used
• Most people fully recover from minor corneal
abrasions without permanent eye damage.
• However, deeper scratches can cause corneal
infections, corneal erosion, or scarring of the
cornea.
• If not treated properly, these complications
can result in long-term vision problems.
• Any unusual symptoms, including a recurrence
of pain following healing, should be reported
to your eye doctor.
• Corneal abrasions occur in any situation that causes
epithelial compromise.
• Examples include
– corneal or epithelial disease (eg, dry eye),
– superficial corneal injury or ocular injuries (eg, those due to
foreign bodies),
– exposure to ultraviolet light, and contact lens wear (eg,
daily disposable soft lenses, extended-wear soft lenses, gas-
permeable lenses, hard polymethylmethacrylate lenses).
• Spontaneous corneal abrasions may be associated
with map-dot-fingerprint dystrophy or recurrent
corneal erosion syndrome.
• A traumatic corneal abrasion is the classic corneal abrasion in which mechanical
trauma to the eye results in a defect in the epithelial surface.
• Common causes of traumatic corneal abrasions include the following:
– Fingernails
– Animal paws
– Pieces of paper or cardboard
– Makeup applicators
– Hand tools
– Branches or leaves
– Thermal burns and ultraviolet light burns
• Foreign body abrasions are typically caused by pieces of metal, wood, glass,
plastic, fiberglass, or vegetable material that have become embedded in the
cornea
• Contact lens–related abrasions are defects in the corneal epithelium that are left
behind after the removal of an overworn, improperly fitting, or improperly
cleaned contact lens. In these cases, the mechanical insult is not from external
trauma but rather from a foreign body that may be associated with specific
pathogens.
• Patients with a corneal abrasion typically complain of eye pain and an
inability to open the eye because of foreign body sensation.
• The severity ranges from a mild foreign body sensation in cases of small
abrasions to excruciating pain in large abrasions.
• Often, patients are too uncomfortable to work, drive, or read, and the
pain frequently precludes sleep.
• Multiple attempts by the patient to "wash out" the eye can further
disrupt the epithelial surface.
• Other symptoms include photophobia, especially if secondary traumatic
iritis is present, pain with extraocular movement, or blurred vision.
• Excessive tearing may occur.
• Conjunctival injection and eyelid swelling may be present.
• Most patients with concomitant atraumatic iritis can clearly distinguish
between the aching discomfort from ciliary spasm and the foreign body
sensation or scratchy discomfort from superficial corneal injury.
• If the source of injury is uncertain, the clinician should
take a detailed history, with questions regarding
– any recent sports activities,
– ultraviolet light exposure,
– makeup application,
– excessive rubbing of the eyes,
– use of contact lenses (including poorly fitting lenses and
duration of use),
– and motor vehicle accidents.
• The occupation of the patient should be noted
because certain people exposed to metals may have
penetrating globe injuries.
• The diagnosis of corneal abrasion can be confirmed
with slitlamp examination and fluorescein
instillation.
• Prophylactic topical antibiotics are given in patients
with abrasions from contact lenses, who are at
increased risk for infected corneal ulcers, but many
emergency physicians have stopped using these
agents for minor injuries.
• Patching the eye is a traditional measure, but it is not
supported by research and should not be performed
in patients at high risk of eye infection. Pain relief is
important.
• Antibiotics may be used to prevent infection.
– Ofloxacin ophtalmic
– Trimethoprim / polymyxin B ophtalmic
– Ciprofloxacin
– Norfloxacin
– Erythromycin ophtalmic
– Sulfacetamide ophtalmic
– Tobramycin ophtalmic
– Gentamicin
• Anticholinergics can reduce pain and photophobia in patients with large corneal abrasions.
– Scopolamine
– Cyclopentolate HCl 1%
– Atropine
• Topical anesthetics are used for analgesia to facilitate an adequate examination.
– Tetracaine
– Proparacaine ophtalmic
– Diclofenac (NSAID)
– Ketorolac thromethamine 0,5% (NSAID)
– Hydrocodone bitartrate and acetaminophen
– Oxycodone and acetaminophen
• Analgesics are indicated, as corneal abrasions can cause severe pain.