• 
  

  • Suspected corneal abrasion.

  
  

  • History of eye trauma, prolonged use of contact lenses, or irritability in a nonverbal patient.

  
  

  • Abnormal vision.

  
  
  
  
  • 
    

    • Decreased visual acuity.

    
    

    • Diplopia.

  
  

  • Abnormal sensation.

  
  
  
  
  • 
    

    • Eye pain.

    
    

    • Photophobia.

    
    

    • Foreign body sensation.

  
  

  • Abnormal appearance.

  
  
  
  
  • 
    

    • Blepharospasm.

    
    

    • Tearing.

    
    

    • Conjunctival erythema.

    
    

    • Visible corneal defect.

    
    

    • Visible corneal foreign body.

Absolute

• 
  

  • Penetrating trauma with suspected globe rupture.

  
  

  • Chemical burn.

  
  

  • Retained contact lens.

  
  

  • Hypersensitivity to fluorescein.

  
  

  • Eye patching of an abrasion caused by a contact lens or a contaminated surface is contraindicated due to increased risk of infection.

Relative

• 
  

  • Suspected minor chemical burn.

• 
  

  • Examination gloves.

  
  

  • Sterile isotonic irrigation solution (0.9% saline or lactated Ringer’s). Copious tap water at room temperature is an acceptable alternative to prevent treatment delay.

  
  

  • Topical ophthalmic anesthetic solution (proparacaine 0.5% or tetracaine 0.5%).

  
  

  • Fluorescein dye (single-dose dropper or dye-impregnated ophthalmic paper strip).

  
  

  • Cobalt blue light (handheld direct ophthalmoscope or slit lamp) or ultraviolet light (Wood’s lamp).

  
  

  • Eye patch (occlusive or standard).

• 
  

  • Hypersensitivity reaction to fluorescein.

  
  

  • Permanent fluorescein staining of a contact lens.

  
  

  • Iatrogenic corneal abrasion if fluorescein strip touches the eye.

  
  

  • Eye patching may increase discomfort and risk of infection.

• 
  

  • A corneal abrasion is a simple scratch limited to the corneal epithelial surface.

  
  

  • A corneal or conjunctival foreign body is irritating, and rubbing may lead to further abrasions.

  
  

  • Suspect an embedded eyelid foreign body when no object can be visualized and symptoms are persistent.

  
  

  • Copious irrigation and mechanical removal of a persistent foreign body is necessary to prevent further abrasions.

  
  

  • If possible, do not apply a topical ophthalmic anesthetic until a foreign body is visualized or you are confident that none is present.

  
  
  
  
  • 
    

    • Patients can help localize a foreign body but sensation will be eliminated by the topical anesthetic.

    
    

    • Patient’s inability to feel increases the potential for abrasions since there is no further pain or apprehension with blinking, eye movement, or rubbing.