Letter Re: What to do for a “scratched eye” (corneal abrasion)

Good morning:

I wonder if any survival blog readers would know what to have on hand as far as medication for a “scratched eye.” (corneal abrasion) We have had several of these over the years, and none of those have happened in a situation where you would have had “protective eyewear” on. I would hate to be without medication should this happen when SHTF. Any suggestions? Thanks, – MB

Cynthia J. Koelker, MD Responds: What if gritty dirt blows in your eyes? Or you scratch your cornea with a fingernail? Or you’re working under your car and debris falls in your face?

And what if afterward your eye won’t stop tearing, and is bothered by light, and hurts almost more than you can stand?

And what if there’s no doctor to help? Will you suffer permanent damage; will you go blind? How long can you stand the pain?

Corneal abrasions are common, and you need to know how to handle them and what to expect if and when you’re on your own.

The cornea overlies the iris (the colored part of the eye), and unlike the sclera (the white part of the eye), the cornea is exquisitely sensitive when damaged. Pain is generally what drives people to the doctor.

If you’ve experienced the above symptoms, you’ve likely suffered a corneal abrasion. Just remember, not everything that acts like a corneal abrasion is one. Instead you may have a foreign body in your eye. Or, perhaps, you have an infection that you’re blaming on dust in your eyes. Or maybe you’ve worn your contacts too long and have irritated your eyes.

Then there are people who believe they have something in their eyes when actually they have a corneal abrasion instead. This scenario is fairly common.

Therefore, the first challenge is to make the correct diagnosis. Whenever anyone suffers an eye injury, the eye should be inspected for visible damage, bleeding, or foreign bodies. Signs of serious damage also include unequal pupils, fluid leaking from the eyeball, or penetration into the eyeball. Anyone with these symptoms should see an eye specialist (ophthalmologist), if at all possible. Fortunately these injuries are rare.

It’s also vital to check the vision; you’d be surprised how often this is omitted when a patient presents to a doctor with eye symptoms. Before any intervention (and afterward as well) vision should be tested (and documented). Any significant loss of vision should be evaluated by a specialist.

As a general rule, before a doctor checks for a corneal abrasion, he or she inspects the eye for a foreign body. Foreign bodies are fairly common, and often can be flushed out with clean water or saline solution, or gently removed with a soft Kleenex or cloth. If possible, the upper eyelid should be gently everted (turned inside out) to check for hidden debris. Embedded objects, which won’t remove easily, should also be treated by a professional. A doctor with a steady hand may remove such an object with the tip of a needle, using a tangential approach (that is, not poking toward the eye at all). This should not be attempted by the layman and is almost impossible to do without first numbing the eye. Embedded metal objects may leave a rust ring, which should only be treated by a professional as well.

Much more common is a scratch of the cornea. Corneal abrasions are usually not visible to the naked eye, but occasionally you may be able to see a rough looking area instead of the glassy smoothness of an intact cornea. Even a small abrasion of only a few millimeters can hurt like crazy but may only be visible with special staining. Corneal abrasions are usually visualized using fluorescein dye and a cobalt blue light. Some doctors numb the eye before staining, but it is possible to do so without topical anesthetic, though the fluorescein burns a little. The orange dye stains damaged tissue and appears a greenish-yellow color under the cobalt blue light. The dye should be rinsed from the eye afterwards.

Corneas damaged from prolonged contact lens wear may show similar fluorescent staining as well, as may flash burns and herpes infection of the eye. A damaged cornea with no history of trauma raises the question of infection; these patients should be referred to an ophthalmologist, if available.

Once the diagnosis is established, treatment should be aimed at prevention of infection and pain control. Although the benefit of topical antibiotics is debatable for mild cases, traditionally they are still prescribed for all corneal abrasions, especially those due to trauma, foreign bodies, or contaminated debris. Erythromycin ophthalmic ointment is soothing and probably my favorite, though others are available. Ciprofloxacin is a better choice for contact lens wears, as their eyes are commonly colonized with Pseudomonas. (A potentially infected contact lens must be discarded and lens wear should be avoided until the eye is well.) When available, a topical eye antibiotic should be applied about four times daily, until symptoms have been resolved for about 24 hours.

However, for a TEOTWAWKI situation, it is unlikely that you will have access to topical eye antibiotics, and your doctor is unlikely to prescribe them “just in case.” Oral antibiotics for 2–4 days would be a second choice; an erythromycin antibiotic should be used for most people, or ciprofloxacin may be used by contact lens wearers.

Regarding pain, if you happen to have topical eye anesthetic, DO NOT use it more than once (for diagnosis or foreign body removal) as this may slow healing and hide worsening symptoms. OTC anti-inflammatory drugs (ibuprofen, naproxen, aspirin) are helpful, though patients often receive more relief from narcotics. A corneal abrasion is a good time to “sleep it off.” Since you’ll likely not have strong pain medication available, taking an OTC sleep aid may help you through the first 24 hours, when pain is at its worst. Doxylamine is one of the most sedating OTC antihistamines (found in Nyquil). Doctors sometimes prescribe eye drops for pain, but again access to these is unlikely. Lubricating drops may be of some benefit.

Although patching of the scratched eye has long been part of standard care and seems a logical thing to do, a review of the medical literature has shown that patching the eye is not beneficial in terms of rate of healing or pain relief. However, if a patient is more comfortable wearing a patch, that’s still okay, but the eye should be re-checked daily until healed, which should not be longer than about 48 hours. Some children or the elderly may find it difficult to walk with the lack of depth perception eye patching causes. Anyone who is prone to rubbing the eyes may also benefit from patching.

Regarding healing, many corneal abrasions resolve within 24 hours and most within 48 hours. If symptoms are not nearly gone or at least significantly better after two days, something else may be going on. Again, hopefully you’ll have access to an eye specialist. (There should still be a few at TEOTWAWKI, and they’re not likely to be filling their days performing laser surgery.)

If properly cared for, it is rare that a corneal abrasion leads to permanent eye damage. Without proper care, however, infection may invade, leading to permanent scarring, partial vision loss, or even blindness.

Below is a summary of needed supplies to treat a suspected corneal abrasion, These will stand you in good stead should you happen to scratch your cornea when no doctor is available:

Cynthia J. Koelker, MD is the Medical Editor for SurvivalBlog and Author of Armageddon Medicine, at www.ArmageddonMedicine.net.

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