Synopsis
Differentiate a superficial epithelial injury from microbial keratitis and penetrating trauma, remove suitable foreign material safely, and prescribe a clear treatment and review plan.
- Check the mechanism before calling an injury superficial: grinding, hammering or mowing can propel a fragment through a tiny entry wound.
- Record visual acuity in each eye, examine the pupils and anterior chamber, and use fluorescein to define the epithelial defect.
- Vertical scratches suggest material beneath the upper lid; evert the lid only when examination has excluded a suspected open globe.
Key red flags
A white corneal infiltrate with an epithelial defect, especially in a contact-lens wearer, requires urgent ophthalmology review for microbial keratitis rather than routine abrasion treatment.
Investigation priorities
Identify functional loss and whether high-energy penetration is plausible.
Management branches
A person presents with a painful watering eye after trauma or a suspected foreign body.
- Record the event, contact-lens use and acuity, inspecting for pupil or anterior chamber abnormalities and corneal infiltration before manipulating the surface.
- If penetration is plausible, apply a rigid protective shield without pressure and arrange emergency ophthalmology assessment rather than attempting office removal.
Key medicines
Chloramphenicol 1% eye ointmentApply an approximately 1 cm ribbon to the affected eye four times daily for five days under the cited Moorfields abrasion protocol.
Proxymetacaine 0.5% procedural eye dropsInstil one or two drops topically immediately before suitable superficial foreign-body removal by a trained clinician, then stop procedural use.