November 2015 Online Photo Diagnosis

November 2015 Online Photo Diagnosis

By William Townsend, OD, FAAO

This digital image of a corneal abrasion, specifically a paper cut, occurred when this 14-year-old male and some classmates were scuffling at school. He immediately experienced moderate-to-severe pain that was exacerbated by blinking. He also reported a noticeable decrease in vision. Presenting visual acuity in the affected eye was 20/25, 20/20 in the fellow eye.

Biomicroscopy revealed an almost perfectly linear lesion that extended through the full thickness of the corneal epithelium and stained brightly with sodium fluorescein. The anterior chamber was quiet, and there was minimal conjunctival injection. He denied photophobia.

We instilled two drops of Besivance (besifloxacin ophthalmic suspension) 0.6% (Bausch + Lomb) and applied a silicone hydrogel bandage contact lens. We advised the patient and his parents to immediately report redness, blurred vision, or any other changes in his ocular status. One week later, when the patient returned, the lesion had completely resolved with no evidence of scarring, and visual acuity was 20/20 OD and OS.

Individuals who incur corneal abrasions frequently report foreign body sensation, severe pain, and sensitivity photophobia.1 The severity of symptoms often necessitates time away from work or school. While there are numerous studies and articles directed at corneal abrasions, a literature search directed specifically at paper cut corneal abrasions was unproductive. Corneal abrasion reportedly occurs in the United States at a rate of 3 per 1,000 persons.2 In an epidemiologic survey of U.S. automobile manufacturing plants, Wong et al reported that superficial foreign bodies and corneal abrasions account for 87% of eye-related injuries.3 Seventy-five percent of workers who experienced a work-related eye injury were not wearing protective eye wear.3

In our patient’s case, the outcome was excellent. Our understanding of corneal wound healing as a complex and fascinating process is continually expanding. It is not, as we once might have assumed, a passive process. For instance, epithelial wound healing relies on remodeling of the basement membrane and on the functions of limbal stem cells.4

An extensive discussion of this subject is beyond the scope of this article, but I would highly recommend “Progress in corneal wound healing” by Ljubimov and Saghizadeh4 as an excellent resource for updated concepts in how the cornea repairs itself.

1. Ahmed F, House RJ, Feldman BH. Corneal Abrasions and Corneal Foreign Bodies. Prim Care. 2015 Sep;42:363-375.

2. McGwin G Jr, Xie A, Owsley C. Rate of eye injury in the United States. Arch Ophthalmol. 2005 Jul;123:970–976.

3. Wong TY, Lincoln A, Tielsch JM, Baker SP. The epidemiology of ocular injury in a major US automobile corporation. Eye (Lond). 1998;12 (Pt 5):870-874.

4. Ljubimov AV, Saghizadeh M. Progress in corneal wound healing. Prog Retin Eye Res. 2015 Jul 18. pii: S1350-9462(15)00049-X.