Scratched Eye? What to Do About a Corneal Abrasion

A corneal abrasion is a scratch on the cornea, the clear dome that covers the colored part of your eye. It usually hurts a lot, makes the eye water and makes light uncomfortable. Rinse the eye gently, don't rub it, and get it checked the same day so it can heal without infection.

The cornea is packed with nerve endings. That's why a tiny scratch can feel like there's a boulder in your eye. The good news is that the cornea also heals quickly when it's cared for the right way.

How does an eye get scratched?

It usually happens fast and by accident. Common causes include:

• A fingernail, including your own when rubbing your eye
• A baby or toddler grabbing at your face
• A mascara wand or makeup brush
• A tree branch, shrub or palm frond during yard work
• A contact lens that's torn, dry or worn too long
• Dust, sand, sawdust or grit blown into the eye
• A small object that lands on the eye and stays there

That last one, a foreign body, matters. If something is stuck on the eye or under the lid, every blink can scratch the cornea again.

What does a corneal abrasion feel like?

Most people know right away that something is wrong. Typical symptoms are:

• Sharp or burning pain
• Lots of tearing
• Sensitivity to light
• Feeling like something is stuck in the eye, even after it's gone
• Blurry vision
• Redness
• Trouble keeping the eye open

These symptoms overlap with other problems, including infections and inflammation inside the eye. Our post on red eye causes covers some of those. An exam is how we tell them apart.

What should I do right away?

Here's what I tell my own family.

Do:

• Rinse the eye with sterile saline or clean, lukewarm water
• Blink several times to help wash out small particles
• Gently pull the upper lid out and down over the lower lid, then let it go. The lower lashes can sometimes sweep a speck off the inside of the upper lid
• Wear sunglasses if light hurts
• Call your eye doctor for a same-day visit

Don't:

• Rub the eye. It can drag a particle across the cornea and make the scratch bigger
• Try to pull out something stuck on the eye with tweezers, a cotton swab or your finger
• Use leftover eye drops, or drops borrowed from someone else
• Tape a tight patch over the eye unless a doctor tells you to
• Put your contact lens back in, even if the eye starts to feel better

When is a scratched eye an emergency?

Some injuries are more than a scratch.

Go to the emergency room right away if:

• The injury happened while grinding, drilling, hammering metal on metal, or using a power tool
• Something hit the eye at high speed, like a lawn mower or string-trimmer fragment
• Something is sticking out of the eye
• The eye is cut, the shape of the pupil looks off, or there's blood inside the eye
• You have sudden, severe vision loss

These can cause a penetrating injury, where something actually goes through the eye wall. It may not hurt as much as you'd expect. Don't press on the eye. Cover it loosely with a shield or the bottom of a paper cup and get help.

Chemical splash: Rinse first. Flush the eye with clean, lukewarm water for at least 15 minutes, holding the lids open. Then go to the emergency room. Rinsing in those first minutes matters more than anything else.

What happens at the eye exam?

First, we check your vision. Then we may place a numbing drop so you can open the eye comfortably. That drop is only for the exam. Numbing drops should never be used at home, because using them repeatedly can damage the cornea.

Next, we use fluorescein, an orange dye that glows under a blue light. It lights up any scratch so we can see its exact size and location under the microscope. We also flip the upper lid to look underneath, since a tiny particle hiding there is a common reason a scratch won't heal.

If something is stuck on the surface of the eye, we can often remove it right in the office. Anything deep, or anything that has gone into the eye, gets referred to the right specialist.

Treatment usually includes:

• Antibiotic drops to help prevent infection while the scratch heals
• Pain control, which may include over-the-counter pain relievers and sometimes a prescription drop
• A follow-up visit to make sure the scratch closed and no infection started

Why are contact lens wearers different?

A scratch plus a contact lens is a risky combination. Germs on the lens can get into the scratched area and cause a corneal ulcer, an infection that can scar the cornea and affect vision.

If you wear contacts, we choose antibiotics that cover the germs more common in lens wearers, and we generally avoid patching. Leave your lenses out until we say it's safe. Bring your lenses and case to the visit, and plan on a fresh pair afterward.

How long does a corneal abrasion take to heal?

Small, clean abrasions often feel much better within a day or two. Larger or deeper ones take longer. Even if you feel fine, keep your follow-up. Feeling better and being fully healed are not always the same thing.

What is recurrent corneal erosion?

Sometimes the surface heals but doesn't stick down firmly. Weeks or even months later, you might wake up with sudden pain, tearing and light sensitivity, often when you first open your eyes in the morning. That's called recurrent corneal erosion. It's very treatable. A lubricating ointment at bedtime is a common first step, and your eye doctor can talk through other options if it keeps happening.

How can I prevent a scratched eye?

• Wear safety glasses for yard work, weed eating, woodworking and DIY projects
• Keep fingernails trimmed, especially if you have a baby who loves grabbing faces
• Wear protective sports eyewear for racquet sports, basketball and baseball
• Replace contact lenses on schedule and never sleep in them unless prescribed for that
• Be careful with makeup applicators, especially in a moving car

How we do it at Bolt Eye Group

At Bolt Eye Group, we offer same-day visits for red, painful or injured eyes at all five offices, on the days each office is open. We examine the eye under the microscope with fluorescein dye, check under the lid for anything hiding there, and remove foreign bodies stuck on the surface of the eye. If an injury needs emergency or surgical care, we'll tell you plainly and send you to the right place.

We accept VSP, EyeMed, Davis Vision, Spectera, Medicare and major medical plans, including Blue Cross Blue Shield, Aetna, UnitedHealthcare, Cigna and Humana. HSA/FSA and CareCredit are accepted. Want to know more about what an optometrist handles? Read optometrist vs. ophthalmologist.

Frequently asked questions

Will a corneal abrasion heal on its own?

Many small scratches do heal quickly, but an exam is still important. We need to make sure nothing is stuck in the eye, the scratch isn't infected, and it isn't something more serious that looks like a scratch.

Should I patch my eye?

Not unless your eye doctor tells you to. Patching isn't routinely needed, and it's generally avoided for contact lens wearers because of infection risk.

When can I wear my contacts again?

Only after your eye doctor confirms the cornea has healed and there's no infection. Start with a fresh pair of lenses and a clean case.

Why does my eye hurt again weeks after the scratch?

That may be recurrent corneal erosion, where the healed surface loosens again, often first thing in the morning. Call us so we can check it and talk about treatment.

Book an exam at your nearest Bolt Eye Group office

Scratched or injured eye? Call us for a same-day visit at your nearest Bolt Eye Group office in Canton, East Cobb/Marietta, Lawrenceville, Riverdale or Johnson City, TN. See all locations and directions.