Medical Description

Corneal staining refers to the appearance of corneal abrasions when dyed with fluorescein drops during an eye examination. Fluorescein temporarily stains the surface of the cornea of the eye. An eye doctor looking at the eye’s surface through a slit lamp observes the abrasions as brightly-colored spots on an otherwise smooth cornea. The cornea, or the eye’s transparent skin, extends over the colored part of the eye (iris), the pupil, and the anterior chamber which is located in front of the lens. Along with the lens, the cornea refracts light and provides the eyes with focusing power. The doctor will note the severity of abrasions and the location and the number of abrasions and try to determine a cause for the irregularity of the cornea as well as prescribe treatment. Sometimes staining is graded in severity from zero to four, with zero indicating no staining and four indicating the most severe staining. Vision can be affected if the abrasion traverses the central visual axis or if a reaction to the abrasion has occurred in the anterior chamber.

Risk factors for corneal abrasions include:

• corneal perforation,
• corneal ulcer (microbial keratitis),
• keratitis or keratoconjunctivitis,
• epithelial erosions, and
• ultraviolet keratitis.

Sources: Nichols Kelly K. et al “Corneal staining in hydrogel lens wearers”, CAT.INIS, 2006; Assessment Of The”Red Eye”, Corneal Abrasion, The Ophthalmology Teaching Website, University of Toronto, July 9, 2004.

Symptoms

• Eye pain, tearing of the eyes, and feeling as if there is something in the eye
• Photophobia and spasm of the eyelids
• Redness in the white part of the eye
• Visual problems

General Information

There may be multiple causes of cornea abrasion. Injuries from fingers, fingernails, branches, mascara brushes, or simply rubbing the eye are frequent causes of corneal abrasion. Automotive front seat air bag deployment, and wind blown particles, such as sand, dirt, or debris, can also cause corneal abrasions. Foreign bodies can become embedded beneath the eye lid and cause abrasions. Corneal abrasion, sometimes called corneal staining because of the process used to identify abrasions to the cornea, is also associated with the use of multipurpose contact lens cleaning solutions, such as Bausch and Lomb’s ReNu MultiPlus, ReNu MoistureLoc, and ReNu MoisturePLUS products.

Because extended soft contact lens use can also cause corneal staining, contact lens wearers may be asked to wear their lenses from two to four hours before they undergo staining in order for the doctor to observe the condition of the eye while wearing their contact lenses. Rapid corneal epithelial healing may mask corneal staining.

Treatment of Corneal Staining

Treatment of corneal staining and mild corneal abrasions usually consists of topical antibiotic ointments which prevent infection and also lubricate the eye’s surface. Some eye doctors do not use antibiotics for mild abrasions because there is some dispute about antibiotics slowing corneal epithelial healing.

Abrasions caused by contact lenses will be treated by antibiotics because of the likelihood of these patients developing keratitis. Antibiotic drops may be more comfortable for patients but they require more frequent administration.

If there is perforation of the surface of the eye, a large abrasion or a dirty abrasion, or if injury was caused by a metallic foreign body, then the Center for Disease Control’s tetanus immunization recommendations should be followed for tetanus boosters.

Recovery from Corneal Staining

Minor abrasions will usually heal in two days. Contact lens wearers sometimes are asked to go without wearing their lenses for a prescribed time period. Large abrasions need to be checked every two days until the corneal epithelium is healed. Patients are advised to rest the eye and to wear sunglasses if light hurts the eyes. If the abrasion is severe, then systemic narcotic pain reliever may be needed. Contact lens wearers are urged to replace their lenses frequently according to their doctor’s instruction, learn the proper hygiene needed for cleaning lenses, and to stay informed regarding lens cleaning and storage products. Some abrasions will require eye patching for healing. Contact lens wearers will not usually be patched as they are at greater risk of secondary infection and corneal ulcer formation.

Sources: Andrew Farrell, Corneal Staining ReNus Concerns, Forbes.com, April, 2, 2007; Robert M Howell, MD, “Corneal Abrasion”, Emedicine March 28, 2005; Cornea, Wikipedia, April 19, 2007.

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