University of Kansas School of Medicine, Wichita, KS 67214, USA.
Am Fam Physician. 2013 Jan 15;87(2):114-20.
Corneal abrasions are commonly encountered in primary care. Patients typically present with a history of trauma and symptoms of foreign body sensation, tearing, and sensitivity to light. History and physical examination should exclude serious causes of eye pain, including penetrating injury, infective keratitis, and corneal ulcers. After fluorescein staining of the cornea, an abrasion will appear yellow under normal light and green in cobalt blue light. Physicians should carefully examine for foreign bodies and remove them, if present. The goals of treatment include pain control, prevention of infection, and healing. Pain relief may be achieved with topical nonsteroidal anti-inflammatory drugs or oral analgesics. Evidence does not support the use of topical cycloplegics for uncomplicated corneal abrasions. Patching is not recommended because it does not improve pain and has the potential to delay healing. Although evidence is lacking, topical antibiotics are commonly prescribed to prevent bacterial superinfection. Contact lens-related abrasions should be treated with antipseudomonal topical antibiotics. Follow-up may not be necessary for patients with small (4 mm or less), uncomplicated abrasions; normal vision; and resolving symptoms. All other patients should be reevaluated in 24 hours. Referral is indicated for any patient with symptoms that do not improve or that worsen, a corneal infiltrate or ulcer, significant vision loss, or a penetrating eye injury.
角膜擦伤在初级保健中很常见。患者通常有外伤史，并伴有异物感、流泪和畏光等症状。病史和体格检查应排除眼痛的严重原因，包括穿透性损伤、感染性角膜炎和角膜溃疡。角膜荧光素染色后，正常光线下擦伤处呈黄色，钴蓝光下呈绿色。医生应仔细检查是否有异物，并在有异物时将其清除。治疗的目的包括控制疼痛、预防感染和促进愈合。可通过局部使用非甾体抗炎药或口服止痛药来缓解疼痛。有证据表明，对于单纯性角膜擦伤，局部使用睫状肌麻痹剂并无益处。不建议进行包扎，因为包扎不能缓解疼痛，反而有可能延迟愈合。尽管缺乏证据，但为了预防细菌继发感染，常开具局部抗生素进行治疗。与隐形眼镜相关的擦伤应使用抗假单胞菌的局部抗生素进行治疗。对于小面积（4 毫米或以下）、无并发症的擦伤患者，视力正常，症状缓解，可能无需随访。其他所有患者都应在 24 小时后重新评估。对于症状无改善或加重、角膜浸润或溃疡、视力显著下降或穿透性眼外伤的患者，应进行转诊。
