Corneal abrasions in children causes symptoms and treatment methods

Corneal scratches in children are a common issue that worries many parents, especially since the eye is a very sensitive organ. Even a minor scratch can cause severe pain, constant tearing, and light sensitivity, making the child uncomfortable most of the time. Understanding the causes, symptoms, and rapid treatment of corneal scratches helps protect the child from potential complications such as infection or vision impairment. In this article, we will cover everything about corneal scratches in children: from causes and symptoms to diagnosis and treatment, along with essential prevention tips to avoid future problems.

What Are Corneal Scratches in Children?
Corneal scratches are scratches on the cornea, the transparent curved surface that covers the front of the eye. These scratches require prompt medical attention to prevent vision problems, infections, or corneal ulcers.

How Can You Tell if Your Child Has a Corneal Scratch?
You may notice these signs:

  • The child complains of severe eye pain.

  • Constant tearing without an obvious cause.

  • Redness and sensitivity to light.

  • The child feels like there is "something in the eye."

Are Corneal Scratches Dangerous?
Most scratches are superficial and heal quickly with proper treatment.
However, if the scratch is deep or not treated properly, it can cause:

  • Eye infections.

  • Corneal scarring.

  • Temporary or permanent vision impairment.

Will the Child’s Vision Be Affected After a Scratch?

  • Superficial scratches: Vision usually remains unaffected.

  • Deep scratches or scratches near the center of the cornea: Vision may be temporarily blurry and requires monitoring by an eye specialist.

Should I See an Eye Doctor Immediately?
Yes. Any corneal scratch in children requires a prompt medical examination, even if it seems minor—especially if the child struggles to open their eye or the pain is severe.

What Treatment Will the Child Receive?

  • Usually antibiotic eye drops or ointments.

  • Sometimes lubricating drops to reduce irritation.

  • In rare cases, minor surgery may be needed if the scratch is deep or a foreign body is present.

Can I Do Anything at Home Before Visiting the Doctor?

  • Rinse the eye with clean saline solution to remove any foreign particles.

  • Prevent the child from rubbing the eye to protect the cornea.

  • Keep the child calm and limit movement.

  • Apply a cold compress to the outer eyelid to reduce pain and redness.

Can Corneal Scratches Recur?
Yes, sometimes if the cornea is weak or the child rubs the eye before full healing, scratches can recur. Regular follow-ups with an eye doctor are essential to prevent recurrence and ensure complete healing.

How to Prevent Corneal Scratches in Children?

  • Supervise children during play to avoid injuries.

  • Teach children not to rub their eyes, especially if a foreign object is present.

  • Use protective eyewear during sports or outdoor play.

  • Maintain hand hygiene to reduce the risk of germs entering the eye.

Stages of Corneal Scratches in Children:
Stage 1: Moment of Injury (Sudden Irritation and Pain)

  • Occurs when the cornea is scratched suddenly (with a fingernail, foreign object, or dust).

  • The child experiences sudden pain, excessive tearing, and light sensitivity.

  • Sometimes the child feels like there is "sand" in the eye and finds it difficult to open.

Stage 2: Inflammatory Response (First 24 Hours)

  • The body begins to repair itself, increasing tearing and redness.

  • New corneal cells start forming to cover the scratch.

  • Pain is noticeable but indicates healing is underway.

Stage 3: Early Healing (Days 2–3)

  • New cells gradually cover the scratch.

  • Pain gradually decreases, and the child can open their eye more easily.

  • Light sensitivity and tearing persist but are milder.

Stage 4: Full Recovery (Usually Days 3–5)

  • The corneal surface fully regenerates and regains transparency.

  • Pain, redness, and tearing disappear.

  • Healing is faster for superficial scratches; deep scratches may take longer and require medical follow-up.

Important Note:
If pain does not improve within 48–72 hours, or new symptoms appear such as discharge or vision changes, see an eye doctor immediately, as this may indicate infection or complications.

Main Causes of Corneal Scratches in Children:

  • Accidental injuries: Foreign objects like sand, dust, feathers, or dirt entering the eye.

  • Scratching with nails: Common, especially in infants and young children learning to control movements.

  • Play-related accidents: Eye hits from toys, paper, or tree branches during running or playing.

  • Rubbing the eye vigorously: Whether or not a foreign object is present, it can scratch the cornea.

  • Contact lenses (if used): Using unclean lenses or wearing them too long can irritate or scratch the cornea.

  • Eye infections or dryness: Weak or sensitive corneas are more prone to scratches even from minor contact.

Symptoms of Corneal Scratches in Children:

  • Eye pain or discomfort: The child may cry or frequently touch their eye.

  • Increased tearing: Obvious excessive eye watering.

  • Eye redness: Visible inflammation and redness on the eye surface.

  • Urge to rub the eye: The child may try to rub constantly, increasing the risk of further damage.

Light Sensitivity: The child may squint or turn their face away from light.

Difficulty Opening the Eye: Sometimes the child cannot open the eye fully or only partially opens it.

Blurred Vision: If the scratch is large, it may temporarily affect vision clarity.

Sensation of Something in the Eye: The child may feel like there is "sand" or "something inside the eye."

If you notice any of these symptoms, seeing an eye doctor immediately is crucial for fast healing and safety.


Types of Corneal Scratches in Children

1. Superficial Scratch:

  • A light scratch on the outer layer of the cornea (epithelium).

  • Symptoms: Pain, tearing, light sensitivity.

  • Healing: Usually within 2–3 days with proper treatment.

2. Deep or Wide Scratch:

  • Extends to deeper layers of the cornea.

  • Symptoms: Stronger pain, slower healing.

  • Requires careful follow-up to prevent infection or scarring.

3. Scratch Caused by a Foreign Body:

  • From a small object like dust, sand, or an eyelash.

  • Removing the foreign body and examining the eye is necessary to avoid damage or infection.

4. Mechanical Scratch:

  • Caused by the child scratching their eye with a fingernail or a sharp toy.

  • Sometimes appears minor but can be deep.

5. Recurrent Scratches (Recurrent Corneal Erosion):

  • Occurs if the cornea hasn’t fully healed from a previous injury.

  • Requires special follow-up and long-term treatment.

Important: All types require an eye exam to determine the appropriate treatment, whether drops, ointments, or additional intervention.


Steps to Diagnose Corneal Scratches in Children

  1. Medical History:

  • The doctor asks about the onset of symptoms: pain, tearing, light sensitivity.

  • Inquires about any preceding incidents: dust, child playing with the eye, or injury during play.

  1. External Eye Examination:

  • Check for redness, eyelid swelling, or irritation signs.

  • Verify if the child can open the eye normally.

  1. Slit Lamp Examination:

  • Magnifies the cornea to clearly see the scratch and determine if it is superficial or deep.

  1. Fluorescein Dye Test:

  • A safe dye is applied to the eye and viewed under blue light.

  • Highlights the scratch as a bright spot for accurate diagnosis.

  1. Check for Foreign Bodies:

  • Ensure no small particles like dust or eyelashes remain, as they may delay healing or cause infection.

  1. Vision Test (if needed):

  • Simple visual acuity test to see if the scratch affects vision, especially if near the cornea center.

After diagnosis, the doctor determines the appropriate treatment: antibiotic drops/ointments, and sometimes an eye patch for deeper scratches.


Risks of Corneal Scratches in Children

  • Bacterial or Viral Infection: Any scratch makes the cornea vulnerable, potentially causing keratitis and vision damage if untreated.

  • Weak Cornea or Scarring: Deep or repeated scratches may cause scarring, reducing corneal transparency and affecting vision.

  • Chronic Inflammation or Recurrent Erosion: Children with weak corneal healing may experience repeated erosion, increasing the risk of partial or complete vision loss.

  • Vision Impairment or Haze: Scratches near the cornea center may cause temporary or permanent blurry vision if untreated.

  • Prolonged Pain and Light Sensitivity: Deep scratches or infections can cause long-lasting discomfort.

  • Secondary Infections in Eyelid or Conjunctiva: Redness or swelling may occur due to infection or ongoing inflammation.

Important Note: Any corneal scratch in children requires prompt eye examination, even if minor, to ensure rapid healing and prevent complications.


Medical Treatment for Corneal Scratches in Children

1️⃣ Superficial Scratches:

  • Antibiotic Eye Drops/Ointments: Prevent bacterial infection (e.g., Tobramycin, Erythromycin).

  • Mild Pain Relief: Lubricating drops or saline to reduce discomfort and tearing.

2️⃣ Deep or Extensive Scratches:

  • Stronger or longer-term antibiotics to prevent infection.

  • Pain Relief: Temporary anesthetic drops in the clinic; sometimes oral painkillers.

  • Eye Patch or Protective Glasses: Prevent rubbing and allow healing.

3️⃣ Scratches from Foreign Bodies:

  • Remove the object under doctor supervision.

  • Follow with antibiotics and lubricating drops/saline to speed healing.

4️⃣ Recurrent Scratches or Weak Cornea:

  • Long-term follow-up with an ophthalmologist.

  • Healing-promoting or cornea-softening drops may be prescribed.

  • Prevent child from rubbing the eye.

Tips:

  • Never use medication without medical advice.

  • Follow prescribed doses and duration to prevent infection or scarring.

  • Monitor child during recovery; if redness, pain, or discharge worsens, return to the doctor.


Cases That May Require Surgical Intervention

  • Very Deep or Extensive Scratches:

    • Reaching the cornea’s inner layers (stroma), threatening transparency.

    • Goal: Remove damaged cells, accelerate healing, and preserve vision.

  • Foreign Body Trapped in Cornea or Under Eyelid:

    • If it cannot be removed with rinsing or saline.

    • Usually done under local anesthesia or brief sedation for infants.

  • Recurrent Corneal Erosion or Weak Cornea:

    • Removal of damaged layer (debridement) to stimulate new healing.

    • Sometimes low-energy laser or modern techniques strengthen the surface to prevent recurrence.

  • Scarring or Haze at Cornea Center Affecting Vision:

    • Remove damaged tissue or partial corneal transplant to preserve sight.

Notes:

  • Surgical intervention in children is generally safe and carefully planned.

  • Most children require short or local anesthesia depending on age and severity.

  • Post-surgery: Close follow-up, antibiotic and lubricating drops, and avoid rubbing the eye.


Preventing Corneal Scratches in Children

  • Supervise Play: Avoid sharp or small objects that may enter the eye (wooden toys, pencils, paper, small balls).

  • Keep young children away from dusty or sandy areas without protection.

  • Teach Not to Rub Eyes: Especially if something enters the eye; encourage washing hands and telling an adult.

  • Hand Hygiene: Reduces germs or foreign particles entering the eye.

  • Eye Protection: Wear goggles during sports or activities involving sand or dust.

  • Avoid Sharp Tools Near Eyes: Scissors, pencils, or shaving tools for older children.

  • Monitor Children with Weak or Previously Damaged Corneas: Regular check-ups.

  • Be Careful with Chemicals or Strong Soap: Hand sanitizers or strong soap may irritate; rinse immediately if contact occurs.

  • Eye Safety Education: Teach older children that eyes are valuable and to avoid deliberate injury or rough play.


First Aid for Corneal Scratches in Children

  • Avoid Eye Rubbing: Prevents further damage to the cornea.

  • Rinse with Sterile Saline: Gently flush out dust or foreign particles; never use sharp objects.

  • Calm the Child and Limit Eye Movement: Reduce discomfort and protect the cornea.

  • Cold Compress: Apply a clean, cold compress to the outer eyelid to reduce pain and redness (never directly on the eye or with pressure).

  • Do Not Use Medication Without Prescription: Incorrect drops may worsen irritation or cause infection.

  • Cover the Eye if Needed: Light patch or protective glasses may prevent rubbing for larger scratches.

  • See an Eye Doctor Immediately: Accurate diagnosis and proper treatment are essential.

Important Note:
If symptoms such as yellow or green discharge, sudden vision loss, or persistent pain after 24 hours occur, urgent medical attention is required.


Table: Corneal Scratches vs. Corneal Abrasions in Children

Item Corneal Scratches in Children Corneal Abrasion in Children
Definition Minor scratch on the superficial corneal layer, usually from mild injury or rubbing Any scratch on the cornea, may be superficial or deep, sometimes more severe
Common Causes Child’s nails, small foreign object, play, eye rubbing Foreign body, direct injury, sharp toys, accidents, contact lenses, weak cornea
Depth Usually superficial (epithelium) Can be superficial or deep, reaching inner corneal layers (stroma)
Symptoms Continuous tearing, mild-to-moderate pain, redness, light sensitivity, difficulty opening eye Severe pain, excessive tearing, redness, light sensitivity, more difficulty opening eye, blurred vision sometimes, discharge if infected
Typical Treatment Antibiotic drops/ointments, lubricants, simple follow-up Antibiotic drops/ointments, pain relief if severe, sometimes eye patch or surgical intervention if deep
Healing Time Usually fast: 2–5 days Depends on depth; may take weeks if deep or recurrent
Possible Complications Rare: minor infection or slight scar More serious: infection, recurrent corneal erosion, central corneal scar, vision impairment