Corneal Abrasion

A Scratch on the Eye Can Be Surprisingly Painful

A corneal abrasion is a scratch or scrape on the cornea, the clear surface at the front of the eye.

Even a very small abrasion can be extremely painful because the cornea contains a very high concentration of nerve endings. Patients often describe a sharp pain, watering, light sensitivity and the feeling that something is stuck in the eye.

Most corneal abrasions heal within a few days. But if they keep happening, particularly when you first open your eyes in the morning, it is important to look beyond the abrasion itself and find out why the corneal surface is repeatedly being damaged.

Don't just treat the scratch. Find out why it happened.

What Does a Corneal Abrasion Feel Like?

Common symptoms include:

• Sharp or gritty eye pain

• A feeling that something is stuck in the eye

• Excessive watering

• Redness

• Sensitivity to light

• Blurred vision

• Difficulty keeping the eye open

• Swollen or uncomfortable eyelids

The pain can be surprisingly intense even when the scratch is very small.

Why Do Corneal Abrasions Happen?

A corneal abrasion can happen after something physically scratches the surface of the eye, such as:

• Dust or sand

• A fingernail

• A branch or plant

• Makeup or cosmetic applicators

• Contact lenses

• Rubbing the eye

• Foreign particles

• Accidental injury

However, some people develop corneal abrasions without any obvious injury.

This is particularly important when the pain occurs first thing in the morning.

Why Does It Hurt When I Open My Eye in the Morning?

If you repeatedly wake up with sudden, severe eye pain, one possibility is a recurrent corneal erosion.

During sleep, the surface of the cornea can become less well lubricated. In some people, the eyelid may stick slightly to a fragile area of the corneal surface.

When the eyelid opens, it can pull on the surface layer of the cornea, causing a new erosion.

This can feel like a corneal abrasion even though there has been no obvious injury.

Dry Eyes Can Make Corneal Abrasions More Likely

A healthy tear film protects and lubricates the surface of the eye.

When you have dry eye disease, particularly poor-quality tears caused by meibomian gland dysfunction, the corneal surface may become more vulnerable.

This is why I don't simply want to treat the abrasion.

If the underlying dry eye is not addressed, the same problem may happen again.

Treat the cause, not just the scratch.

Learn more about Dry Eye Disease →More here

Another Cause: Map-Dot-Fingerprint Corneal Dystrophy

Some people are naturally predisposed to recurrent corneal erosions because of a condition called epithelial basement membrane dystrophy (EBMD).

You may also hear this called:

Map-dot-fingerprint dystrophy

The abnormality affects the way the surface layer of the cornea attaches to the underlying tissue.

This can make the corneal surface more vulnerable to being disturbed when the eyelid opens in the morning.

If you repeatedly experience unexplained corneal abrasions or severe eye pain on waking, it is worth checking whether an underlying corneal condition is contributing.

How Is a Corneal Abrasion Diagnosed?

A corneal abrasion can usually be detected during an eye examination using a special dye called fluorescein.

The dye temporarily highlights areas where the surface of the cornea has been damaged.

I will also look for the reason the abrasion occurred, including:

• Dry eye disease

• Meibomian gland dysfunction

• Eyelid problems

• Recurrent corneal erosion

• Epithelial basement membrane dystrophy

• Contact lens-related problems

• Previous eye surgery

Finding the underlying cause is particularly important if the problem keeps returning.

Treatment for a Corneal Abrasion

Most uncomplicated corneal abrasions feel better within a day, but it takes one month for the roots to anchor itself

Treatment depends on the size and cause of the abrasion and the level of pain and may include:

Lubrication

Preservative-free lubricating drops or ointment can protect the surface and support healing.

However, if the abrasion is very painful, ordinary artificial tears may not provide enough relief.

Antibiotic Treatment

In some cases, an antibiotic eye drop or ointment may be prescribed to reduce the risk of infection.

The need for antibiotic treatment depends on the circumstances and should be assessed by an eye professional.

Bandage Contact Lens

For selected patients, a bandage contact lens can provide significant relief from pain while the corneal surface heals.

This is not the same as a normal cosmetic contact lens. It can stay in the eye for 1 week.

A bandage lens is a therapeutic medical device fitted and monitored by an eye professional. It acts as a protective layer over the cornea while it heals.

For some patients with significant pain, the relief can be remarkable.

What If It Keeps Coming Back?

This is where I think it is particularly important to look beyond the abrasion itself.

If you keep having corneal abrasions, ask:

Why is the surface repeatedly breaking down?

We may need to treat:

• Dry eye disease

• Meibomian gland dysfunction

• Recurrent corneal erosion

• Epithelial basement membrane dystrophy

• Eyelid problems

• Contact lens-related problems

Simply treating each episode without addressing the underlying cause may mean that the cycle continues.

When Should I See an Eye Specialist?

You should have an eye examination if you have:

• Significant or worsening eye pain

• Blurred or reduced vision

• Significant light sensitivity

• Persistent redness or watering

• Symptoms that aren't improving

• Repeated episodes of eye pain

• Pain that occurs repeatedly when opening your eyes in the morning

• An injury involving a chemical or foreign object

• An injury involving metal or another high-velocity particle

• A recent eye operation or contact lens-related injury

Chemical injuries and suspected penetrating injuries require urgent medical attention.

Can I Prevent Corneal Abrasions?

Some simple measures can reduce the risk:

Keep the eyes well lubricated

If dry eye disease is contributing to recurrent abrasions, treating the underlying dry eye is important.

Explore our Dry Eye Resource Centre →

Don't rub your eyes

Rubbing can damage an already irritated corneal surface.

Protect your eyes

Wear appropriate protective eyewear when gardening, doing DIY, woodworking or playing sports where particles may enter the eye.

Take care with contact lenses

Follow the recommended wearing schedule and hygiene instructions. Never continue wearing contact lenses when your eye is painful or red unless advised by your eye professional.