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How to Tell If You Have a Scratched Cornea and What to Do
Common Causes and Risk Factors
Corneal abrasions are one of the most frequent eye injuries we see, and they can happen to anyone. Recognizing the common causes helps you take steps to protect your eyes going forward.
Many corneal abrasions result from ordinary daily activities. A fingernail scratch from a baby or young child is among the most frequent causes, but tree branches, makeup brushes, and even the edge of a piece of paper can injure the corneal surface if they make contact with your eye.
Dust, sand, or wood particles blown into the eye can also scratch the cornea, particularly when someone rubs the eye while the debris is still present. Ultraviolet light from welding arcs or intense sunlight reflected off snow can cause a related type of corneal surface injury called photokeratitis, which produces similar symptoms. Wearing protective eyewear during yard work or windy conditions reduces these risks.
Contact lenses can cause corneal abrasions if they are inserted or removed incorrectly, or if a lens has a torn or damaged edge. Sleeping in lenses that are not approved for overnight wear is a particular risk factor because the cornea receives less oxygen during that time and becomes more vulnerable to injury.
- Handling lenses with dry or unwashed hands
- Wearing lenses beyond their recommended replacement schedule
- Using lenses that do not fit the eye properly
- Failing to clean and disinfect lenses as directed
Certain jobs and hobbies expose your eyes to a greater chance of corneal injury. Construction work, metalworking, and carpentry often involve flying debris or sparks, while athletes who play basketball, racquetball, or other fast-paced contact sports face risks from fingers, balls, or equipment.
Gardening, power tool use, and handling chemicals are also common sources of eye injury. We recommend wearing properly fitted safety glasses or protective goggles whenever you engage in these activities, even for brief periods.
How We Diagnose a Corneal Abrasion
A prompt and thorough eye exam is the safest way to confirm a corneal abrasion and check for any complications. Our eye doctors have the tools and training needed to evaluate your injury carefully and create a treatment plan suited to you.
When you come in with symptoms of a scratched cornea, our eye doctors will start by asking about your recent activities and when your pain or discomfort began. We will check your vision in each eye and examine the surface of your eye using a slit lamp, a specialized microscope that lets us see very fine detail on the cornea.
This examination is usually quick and well tolerated. We apply numbing drops in the office when needed to make the exam more comfortable.
To make corneal scratches easier to see, we use a safe orange dye called fluorescein. A small strip of dye-soaked paper is gently placed against your lower eyelid, or a drop of the dye is applied directly to your eye. When we shine a blue light over the cornea, any scratched areas glow bright green or yellow.
This test is highly effective at revealing even very small abrasions that might not be visible under normal light. The dye washes out naturally with your tears within a few hours and may briefly tint the skin around your eye.
During your exam, we carefully inspect for any foreign material embedded in the cornea or hidden under the eyelids. If we find debris, our eye doctors will gently remove it using sterile instruments or by flushing the eye with saline.
- Measuring the size and location of the scratch
- Determining whether the injury is superficial or affects deeper layers
- Looking for signs of early infection or other complications
- Removing any rust ring if a metallic foreign body has been present
- Considering tetanus status when a penetrating or contaminated injury is suspected
Treatment Options for a Scratched Cornea
The right treatment depends on the size and depth of the scratch, how it happened, and your individual health history. Our eye doctors will walk you through every step and make sure you understand what to expect.
Most corneal abrasions are treated with antibiotic eye drops or ointment to prevent a bacterial infection from developing while the surface heals. We choose the appropriate antibiotic based on the nature of your injury and any risk factors you may have.
- Contact lens wearers typically need an antibiotic that covers a broader range of bacteria, including Pseudomonas, and require closer follow-up
- Ointments can provide extra comfort for non-contact-lens wearers, particularly at bedtime
- Do not use steroid-containing drops unless our eye doctors specifically prescribe them for you
Use the prescribed antibiotic exactly as directed, usually several times a day for several days, and complete the full course even if your eye begins to feel better sooner.
Over-the-counter pain relievers such as acetaminophen or ibuprofen can help reduce discomfort during healing. We may also recommend preservative-free lubricating eye drops to keep the eye moist and soothe irritation, along with cold compresses applied for 10 to 15 minutes at a time.
A short-acting cycloplegic drop placed in the office can ease light sensitivity and reduce the aching that sometimes comes with ciliary muscle spasm. Topical anesthetic drops should not be used at home because they can slow healing and hide symptoms of complications developing. Topical NSAID drops are not routinely recommended for home use and should only be used under our guidance for short periods.
For larger or more painful abrasions, we may place a soft bandage contact lens on your eye. This lens acts as a protective shield over the cornea, reducing pain and allowing the surface to heal more comfortably without requiring you to blink against a raw area.
- The lens remains in place for several days while healing progresses
- You will continue using prescribed eye drops over the lens
- There is a small risk of infection while wearing a bandage lens, so antibiotic drops are used and water exposure must be strictly avoided
- Do not attempt to remove or replace the bandage lens yourself unless we instruct you to do so
Our eye doctors will monitor your healing closely during this period and determine when it is safe to remove the lens.
Deeper scratches or abrasions that do not close within a few days may require additional care. In some cases, our eye doctors may refer you to a corneal specialist for treatments such as amniotic membrane therapy, which uses tissue derived from donated human placenta to support healing and reduce the risk of scarring.
If your injury was caused by organic material such as a tree branch, we will monitor especially closely for signs of fungal or bacterial infection and adjust your treatment plan as needed.
Taking Care of Your Eye During Recovery
What you do at home between appointments has a real impact on how quickly and safely your cornea heals. Following our guidance carefully helps prevent complications and gets you back to normal sooner.
Always wash your hands thoroughly before applying eye drops or touching anywhere near your injured eye. Use all medications exactly as prescribed and never use leftover drops or someone else's medication.
- Do wear sunglasses outdoors to manage light sensitivity
- Do use preservative-free artificial tears frequently to keep the eye moist
- Do discard and replace any contact lenses and lens case used around the time of the injury
- Do not rub or touch your injured eye
- Do not wear regular contact lenses until we confirm your cornea has fully healed
- Do not use makeup on or near the eye until healing is complete
- Do not use steroid drops or redness-reducing drops unless we prescribe them
- Do not try to remove a stuck object yourself
- Do not expose a bandage contact lens to water, pools, or hot tubs
- Do not drive until your vision is clear and light sensitivity is manageable
Most small corneal abrasions heal within one to three days, and many people can return to work or school during that time if their pain is manageable. Larger or deeper scratches may take a week or longer to fully close.
Avoid swimming, hot tubs, and any activity that could expose your eye to dust, debris, or impact until we have confirmed that your cornea has healed. If your job or hobbies involve physical contact or eye hazards, ask our eye doctors when it is safe to resume those specific activities.
We typically schedule a follow-up visit within one to two days of your initial exam to check your healing progress. During this appointment, our eye doctors will look for signs that the scratch is closing properly and that no infection is developing underneath.
If a bandage contact lens was placed on your eye, we will examine the cornea beneath it and decide when to remove it. Continued pain, worsening redness, or new discharge between appointments should prompt you to contact us right away rather than waiting for your scheduled visit.
When to Seek Immediate Care
Some situations involving the eye cannot wait for a regular office appointment. Knowing when to go straight to an emergency department may protect your vision and prevent serious long-term harm.
Certain symptoms signal that a corneal abrasion may be more serious than it appears, or that a different type of injury has occurred. Sudden vision loss, intense pain that does not respond to over-the-counter pain relievers, or any sensation that something has penetrated deeply into your eye all require immediate emergency evaluation.
- Extreme sensitivity to light that makes it impossible to open the eye
- A white or cloudy spot appearing on the cornea
- Increasing redness, swelling, or pus coming from the eye
- A chemical splash or burn to the eye
- High-velocity exposure to a metal fragment from power tools or grinding
- A suspected puncture wound or a pupil that looks irregular or teardrop-shaped
For a chemical injury, begin rinsing the eye immediately with clean water or saline for at least 15 minutes and proceed to the emergency department without delay. For a suspected puncture, do not press on the eye, place a protective shield over it if one is available, and seek emergency care right away.
Without proper care, a corneal abrasion can progress to a bacterial or fungal infection of the cornea called keratitis. This type of infection can cause permanent corneal scarring or significant vision loss if it is not treated promptly with appropriate medications.
Recurrent corneal erosion is another possible complication, in which the scratch fails to heal completely and breaks open again, sometimes weeks or months later. If you experience repeated episodes of sudden eye pain and tearing, especially upon waking in the morning, let our eye doctors know so we can explore preventive treatments to reduce the likelihood of future episodes.
Frequently Asked Questions
These questions address specific situations and decisions that patients often face when dealing with a corneal abrasion. If you have a concern not covered here, our team is always glad to help.
Very minor abrasions sometimes do heal on their own, but an examination is the only way to know how serious the injury actually is. Without a proper evaluation, you have no way to rule out a foreign body, an infection starting, or a deeper injury that needs different treatment. Seeing an eye doctor also means you can get effective pain relief and have someone monitoring your recovery to catch any complications early.
Regular contact lenses should not be worn over a scratched cornea. Lenses can trap bacteria against the damaged surface, reduce oxygen flow, and physically slow the healing process. Our eye doctors will tell you clearly when it is safe to resume lens wear, which is typically only after a follow-up exam confirms the cornea has fully closed.
Patching a scratched cornea is generally not recommended based on current evidence, because it does not speed recovery and can actually make discomfort worse. Keeping the eye open and allowing normal blinking helps wash the surface naturally and keeps it moist, which supports healing. If you are struggling with pain or light sensitivity, sunglasses and lubricating drops are more effective tools than a patch.
Pain that increases rather than decreases after the first 24 hours is a signal that something may need closer attention. It could indicate that a foreign body was missed, that an infection is beginning, or that the abrasion is deeper than it initially appeared. You should contact us promptly if this happens rather than waiting for a scheduled follow-up, since early intervention makes a significant difference in outcomes.
Most corneal abrasions heal completely without any lasting effect on vision when they are treated properly. The situations where vision can be affected long-term are those involving deep scratches that scar the cornea or infections that are allowed to progress. Seeking care promptly and following your treatment plan closely are the most important things you can do to protect your long-term vision after this type of injury.
A chemical injury to the eye is treated differently from a standard corneal abrasion and is a medical emergency. Rinse the eye continuously with clean water or saline for at least 15 minutes, starting immediately, and head to the emergency department while rinsing or right afterward. Bring the chemical container or label with you if it is safe to do so, because knowing the specific substance helps the emergency team determine the most appropriate treatment.
Visit Us for Expert Eye Injury Care
If you think you may have a scratched cornea, NewView Eye Center is here to help with the thorough, compassionate care you deserve. Our experienced eye doctors provide prompt evaluation and personalized treatment for corneal abrasions and a wide range of other eye conditions across Northern Virginia. We welcome you to reach out to our Reston or Leesburg office to schedule an appointment and get on the path to comfortable, clear vision.
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