What are the red flags for corneal abrasion & eye foreign body in urgent care?

High-velocity injury (hammering, grinding, drilling metal) → Penetrating injury — X-ray orbit, ophthalmology same day; Irregular or peaked pupil, shallow anterior chamber, positive Seidel test → Globe rupture — shield (no pressure), ophthalmology now; Chemical injury → Irrigate immediately (until pH neutral), then ophthalmology; Rust ring or embedded corneal foreign body you can’t remove → Eye service; Contact lens-related abrasion → Pseudomonas risk — eye service same day; Reduced acuity, hyphaema → Eye service same day

What should I prescribe for corneal abrasion & eye foreign body?

Chloramphenicol 1% eye ointment: Apply four times a day (About 5 days (or per local protocol)); Paracetamol: 1 g every 4–6 hours, max 4 g in 24 h (reduce if under 50 kg or liver risk) (As needed); Ibuprofen: 400 mg three times a day with food (3–5 days. Avoid: NSAID-sensitive asthma, GI bleed/ulcer, renal impairment, anticoagulants, heart failure, pregnancy)

Corneal Abrasion & Eye Foreign Body | Urgent Care Clinic

Q: What safety-netting advice should I give for corneal abrasion & eye foreign body?

Advise the patient to return or seek help if: Vision worse, or pain getting worse instead of better; Not much better after 2 days; Discharge or increasing redness.

1Rule out first — red flags

If you find…	…then
High-velocity injury (hammering, grinding, drilling metal)	Penetrating injury — X-ray orbit, ophthalmology same day
Irregular or peaked pupil, shallow anterior chamber, positive Seidel test	Globe rupture — shield (no pressure), ophthalmology now
Chemical injury	Irrigate immediately (until pH neutral), then ophthalmology
Rust ring or embedded corneal foreign body you can’t remove	Eye service
Contact lens-related abrasion	Pseudomonas risk — eye service same day
Reduced acuity, hyphaema	Eye service same day

2Focused history

Mechanism: scratch, wind-blown particle, high-velocity metal, chemical
Time, safety glasses worn?
Contact lenses
Pain, photophobia, vision

3Focused examination

Visual acuity first (before anaesthetic drops if possible)
Topical anaesthetic for examination only
Evert the upper lid — look for subtarsal foreign body
Fluorescein with blue light: abrasion, Seidel test
Pupil shape, anterior chamber

4Decide — investigate only if it changes the plan

Investigation	Only if…
Orbital X-ray	High-velocity metal injury (intraocular foreign body)

5Treat & send home

Management & advice

Remove superficial foreign body: irrigation or moist cotton bud (needle only if trained, under slit lamp)
Never send home with topical anaesthetic drops
No eye pad routinely
No contact lenses until healed and reviewed
Most abrasions heal within 24–72 h

Refer / follow-up

Red flags, rust ring, contact lens abrasion, not healed at 72 h → eye service

℞

Discharge prescription (TTO)Typical adult doses — check the BNF/BNFc, allergies, renal function, pregnancy and interactions.

Drug	Dose	Duration / notes
Chloramphenicol 1% eye ointment	Apply four times a day	About 5 days (or per local protocol)
Paracetamol	1 g every 4–6 hours, max 4 g in 24 h (reduce if under 50 kg or liver risk)	As needed
Ibuprofen	400 mg three times a day with food	3–5 days. Avoid: NSAID-sensitive asthma, GI bleed/ulcer, renal impairment, anticoagulants, heart failure, pregnancy

6Safety-net

Say it like this

You’ve scratched the clear front of your eye. It’s very painful but usually heals within 1 to 3 days. Use the ointment four times a day and painkillers. Don’t wear contact lenses. Come back if your vision gets worse, the pain gets worse rather than better, or it isn’t much better in 2 days.

Come back / call 111 — or 999 if severe — if:

Vision worse, or pain getting worse instead of better
Not much better after 2 days
Discharge or increasing redness

7Patient leaflets — scan & go

Official NHS pages. Ask the patient to scan the code with their phone camera, or tap “Show to patient” to make it full screen.

Eye injuriesnhs.uk/conditions/eye-injuries

8Document

Corneal abrasion & eye foreign body — clinic note

A structure to document efficiently. It is not a completeness check — use your trust’s system and your clinical judgement.

URGENT CARE — CORNEAL ABRASION & EYE FOREIGN BODY PRESENTING COMPLAINT: HISTORY Mechanism: scratch, wind-blown particle, high-velocity metal, chemical: Time, safety glasses worn?: Contact lenses: Pain, photophobia, vision: RED FLAGS (record present / absent) [ ] High-velocity injury (hammering, grinding, drilling metal) [ ] Irregular or peaked pupil, shallow anterior chamber, positive Seidel test [ ] Chemical injury [ ] Rust ring or embedded corneal foreign body you can’t remove [ ] Contact lens-related abrasion [ ] Reduced acuity, hyphaema PMH: DRUG HISTORY: ALLERGIES: SOCIAL (job / who is at home / driving): OBSERVATIONS: RR SpO2 HR BP Temp (NEWS2 ) EXAMINATION Visual acuity first (before anaesthetic drops if possible): Topical anaesthetic for examination only: Evert the upper lid — look for subtarsal foreign body: Fluorescein with blue light: abrasion, Seidel test: Pupil shape, anterior chamber: INVESTIGATIONS: none required / Orbital X-ray — result: IMPRESSION: PLAN Treatment / TTO (drug, dose, duration): Advice given: Leaflet given (QR / printed): Eye injuries Follow-up / referral: SAFETY-NETTING (told to return / call 111 / 999 if): - Vision worse, or pain getting worse instead of better - Not much better after 2 days - Discharge or increasing redness Patient understands and agrees with the plan: Y / N Seen by: Grade: Date/Time:

✓Guidelines

Doses are typical adult doses drawn from the guidance above. Always check the current BNF/BNFc and your local antimicrobial policy.

More ear, nose, throat & eyes

Sore throat & tonsillitisFeverPAIN decides — and don’t miss the quinsy or epiglottitis.Earache: otitis media & externaMostly no antibiotics — but spot mastoiditis and malignant otitis externa.SinusitisViral until day 10 — and don’t miss the orbit.Nosebleed (epistaxis)Proper first aid, cautery if you can see it, and who needs ENT.