From the Guidelines
The initial treatment for a corneal abrasion includes pain management with oral analgesics and topical antibiotic prophylaxis, with a broad-spectrum topical antibiotic recommended for any patient presenting with corneal abrasion following trauma, as stated in the most recent study 1. The goal of treatment is to promote healing, prevent infection, and minimize discomfort. For pain relief, oral NSAIDs like ibuprofen (400-600mg every 6 hours) or acetaminophen (500-1000mg every 6 hours) can be used. A topical antibiotic such as erythromycin ointment or fluoroquinolone drops (e.g., moxifloxacin 0.5% or ciprofloxacin 0.3%) should be applied 4 times daily for 5-7 days to prevent infection, as supported by 1. Some key points to consider in the treatment of corneal abrasions include:
- Avoiding contact lens wear until the abrasion is fully healed
- Advising against rubbing the eye
- Considering the use of cycloplegic drops like cyclopentolate 1% or homatropine 2% for severe pain or photophobia to relax the ciliary muscle, as mentioned in 1
- Follow-up within 24-48 hours is recommended to ensure proper healing, as healing can occur quickly due to the corneal epithelium's regenerative capabilities, with cells migrating from the periphery to cover the defect, followed by cell proliferation to restore normal thickness. Patching is no longer routinely recommended as it doesn't improve healing and may increase infection risk, especially in patients with contact-lens associated abrasion, as noted in 1. Overall, the treatment approach should prioritize preventing infection and promoting healing, with regular follow-up to monitor progress and adjust treatment as needed, based on the most recent and highest quality evidence available 1.
From the Research
Initial Treatment for Corneal Abrasion
The initial treatment for a patient with a corneal abrasion includes:
- Pain control: Topical nonsteroidal anti-inflammatory drugs (NSAIDs) or oral analgesics can be used to manage pain 2, 3, 4
- Prevention of infection: Topical antibiotics are commonly prescribed to prevent bacterial superinfection, although evidence is lacking 5, 2
- Healing: The goal is to promote healing of the corneal abrasion
DC Instructions to Patient
DC instructions to the patient may include:
- Applying topical antibiotics and NSAIDs as directed 5, 2, 4
- Using a therapeutic soft contact lens to reduce pain and promote healing 3, 4
- Avoiding patching, as it does not improve pain and may delay healing 2
- Returning for follow-up in 24 hours if symptoms do not improve or worsen 2
- Seeking immediate medical attention if symptoms persist, worsen, or new symptoms appear 6
Additional Considerations
Additional considerations for the treatment of corneal abrasions include:
- Contact lens-related abrasions should be treated with antipseudomonal topical antibiotics 2
- Patients with small, uncomplicated abrasions may not require follow-up, but all other patients should be reevaluated in 24 hours 2
- Referral to a specialist is indicated for patients with symptoms that do not improve or worsen, corneal infiltrate or ulcer, significant vision loss, or penetrating eye injury 2