Corneal abrasion (scratched eye): symptoms, treatment and healing time

Cambridge University Hospitals says abrasions usually heal on their own, but that a nurse or doctor will usually prescribe antibiotic drops or ointment for a few days to reduce the chance of infection. Over-the-counter lubricants may soothe, although natural tears are usually adequate for healing. Painkillers can be taken, though most people find the pain still quite severe for the first two days. Moorfields guidance for clinicians describes antibiotic ointment, oral painkillers such as ibuprofen if tolerated, and review as appropriate.

Eye pads were once widely used. Moorfields describes an optional double pad for 12 to 24 hours in its clinical guidance, noting that it can be removed if uncomfortable, but pad use varies between departments, so follow the instructions you are given. Most patients do not need a further appointment, but a follow-up in the eye emergency clinic may be arranged for contact lens wearers or if there is concern about more extensive injury.

Cambridge University Hospitals says a scratch will be very painful and may also cause sensitivity to light, redness, blurred vision, eyelid swelling and a lot of watering. Moorfields lists immediate pain, watering, a foreign body sensation and light sensitivity.

Wearing sunglasses may help reduce light sensitivity, according to the hospital leaflet.

The cornea is the clear dome at the front of the eye. It lets light in and helps focus it. A corneal abrasion is a scratch or graze to its surface. Because the cornea has a very rich nerve supply, even a tiny scratch produces pain out of proportion to its size, which is why people often find it difficult to keep the eye open.

Moorfields Eye Hospital notes that abrasions are generally the result of trauma to the surface of the eye, and that rubbing the eye after getting grit in it can make matters worse. Most abrasions are minor and heal without lasting effects, but the eye should still be assessed if pain, redness or reduced vision follows an injury.

Cambridge University Hospitals says abrasions usually heal by themselves. The pain and visual disturbance usually resolve in three to four days, and there may be a slight gritty discomfort for a further few days. Most patients do not need a further appointment.

Most people find the pain is still quite severe for the first two days. If the pain has not started to improve after 48 hours, or if vision or pain worsens significantly, the hospital advises contacting the eye emergency service during working hours or attending the emergency department at weekends. A longer-lasting problem can mean the cornea has not healed completely, or that there is an infection, so it should be reviewed.

Cambridge University Hospitals lists injuries from fingernails, hairbrushes, tree branches and paper as common causes, and says grit or other tiny foreign bodies under the eyelid can scratch the cornea too. Moorfields adds that contact lens insertion and removal can cause injuries, and warns that contact lens wearers, especially those who wear soft lenses, can also develop a corneal ulcer, which is more serious.

The NHS advises not touching or rubbing an injured eye until it is better, and not wearing make-up around the eye or contact lenses until it has recovered.

• A fingernail or a child's hand poking the eye.

• A branch, hair brush, make-up applicator or sheet of paper.

• Grit, sand or dust trapped under the upper eyelid and then rubbed.

• Putting in or taking out contact lenses.

The NHS says to go to A&E or call 999 if a strong chemical such as oven cleaner or bleach is in the eye (keep rinsing with water while waiting and take the container), a sharp object has pierced the eye, something has hit the eye at high speed such as when using power tools or mowing, or there are any changes to your sight after an eye injury. Severe pain, a headache or sensitivity to light, feeling or being sick, being unable to move the eye or keep it open, and blood or pus coming from the eye are also on the NHS list. Do not drive yourself.

For less severe problems, the NHS advises asking for an urgent GP appointment or contacting NHS 111 if you have injured an eye and it is not getting better after 24 hours, if you are worried (particularly about a child) or if it is very painful, and says you could visit an optician for advice. Cambridge University Hospitals advises that if pain has not started to improve after 48 hours, or vision or pain worsens significantly, you should contact the eye emergency service.

To wash a foreign body or irritant from the eye, the NHS says to use clean, not hot, water, hold the eye open and run lots of water over the eyeball for at least 20 minutes, with the flow not too strong. It also says not to try to remove an object that has pierced the eye.

Moorfields describes the examination used in eye departments. The clinician looks at the surface of the eye with a bright light to exclude a foreign body or clouding of the cornea, instils a drop of anaesthetic together with fluorescein dye, and looks for staining of the abraded area, preferably under blue light. The upper eyelid may be turned over if grit is suspected, and the clinician checks for signs of a deeper laceration such as a distorted pupil.

Cambridge University Hospitals explains that the anaesthetic drop gives temporary relief for about half an hour, but must only be used during the examination because repeated use can cause permanent damage to the eye and vision. It also says dilating drops may be given to help pain, which can blur vision and prevent safe driving for up to a day.

If you have recently worn contact lenses, Cambridge University Hospitals says you may be advised to be reviewed by an eye department because lenses can sometimes lead to infection of the cornea. Do not use lenses again until one week after the abrasion has healed, and see your optician before restarting.

A small number of people have repeated episodes of pain, because a small area of the corneal surface has not healed completely and is more weakly attached than normal. This is called recurrent corneal erosion, and the area can loosen during sleep so that the eye hurts on waking, sometimes months or years after the injury. The hospital says to consult an optician, and that night-time lubricating ointment may help. If the pain is severe, attend the emergency department.

Where a scratched eye is seen depends on local arrangements, and the NHS says you can ask for an urgent GP appointment, contact NHS 111 or visit an optician for advice. Hospital eye departments, as in the Cambridge leaflet, run eye emergency clinics, with the emergency department used outside their hours.

Private ophthalmologists and eye hospitals can also treat abrasions, usually with quicker access. The initial advice is the same: urgent examination for significant pain, any visual change or contact lens use, and prompt escalation if infection is suspected. Recurrent erosion is a case where a longer-term specialist plan is useful.