From the Guidelines
Untreated corneal abrasions in contact lens wearers can lead to serious complications, including microbial keratitis, corneal scarring, and vision loss, emphasizing the need for prompt treatment and professional evaluation. The most concerning complication is microbial keratitis, particularly from Pseudomonas aeruginosa or Acanthamoeba, which can rapidly progress to corneal ulceration and perforation within 24-48 hours 1. Contact lens wearers are at higher risk because lenses can trap bacteria against the abraded cornea. Other complications include corneal scarring that may permanently impair vision, recurrent corneal erosion syndrome causing repeated episodes of pain and blurred vision, and secondary infections that can spread to deeper eye structures.
Key considerations in managing corneal abrasions in contact lens wearers include:
- Removing contacts immediately and not reinserting them until complete healing and professional clearance
- Seeking urgent eye care
- Treatment with antibiotic eye drops, such as fluoroquinolones (moxifloxacin or ciprofloxacin), every 1-2 hours initially
- Use of cycloplegic drops like cyclopentolate 1% to reduce pain
- Avoiding steroid eye drops without professional supervision as they can worsen infections 1.
Given the potential for rapid progression and severe outcomes, corneal abrasions in contact lens wearers should always be considered potentially sight-threatening emergencies requiring prompt professional evaluation. The use of prophylactic topical antibiotics in patients with corneal abrasions, especially those wearing contact lenses, is recommended to prevent acute bacterial keratitis and fungal infections, as supported by recent guidelines 1.
From the Research
Complications of Untreated Cornea Abrasion in Contact Lens Wearers
- Untreated corneal abrasions in contact lens wearers can lead to severe complications, including vision loss and chronic eye pain 2, 3
- The use of contact lenses with corneal abrasions can increase the risk of infection and delay healing 2
- Topical nonsteroidal anti-inflammatory drugs (NSAIDs) and antibiotic drops have been shown to be effective in reducing pain and promoting healing in corneal abrasions 4, 2, 3, 5
- Bandage contact lenses have also been used to treat corneal abrasions, and have been shown to reduce pain and promote healing 2, 3
Risk Factors for Complications
- Size and depth of the abrasion: larger and deeper abrasions are more likely to lead to complications 2
- Presence of infection: bacterial or fungal infections can lead to severe complications, including vision loss 2
- Use of contact lenses: wearing contact lenses with corneal abrasions can increase the risk of infection and delay healing 2
Treatment Options
- Topical NSAIDs and antibiotic drops: effective in reducing pain and promoting healing 4, 2, 3, 5
- Bandage contact lenses: can reduce pain and promote healing 2, 3
- Pressure patching: may be used to protect the eye and promote healing, but can be uncomfortable and may not be as effective as other treatments 3