What is the recommended treatment for a 2 mm corneal abrasion?

From the Guidelines

The recommended treatment for a 2 mm corneal abrasion includes antibiotic eye drops such as erythromycin ointment or fluoroquinolone drops (like moxifloxacin or ciprofloxacin) applied 4 times daily for 5-7 days to prevent infection. This approach is supported by the most recent guidelines, including the bacterial keratitis preferred practice pattern 1.

Key Considerations

• Pain management should include oral analgesics like acetaminophen or ibuprofen, and cycloplegic eye drops such as cyclopentolate 1% or homatropine 5% can be used to reduce pain from ciliary muscle spasm.
• Patching is no longer routinely recommended as it may delay healing, especially in patients with contact lens-associated abrasions or trauma, due to the increased risk of secondary bacterial keratitis 1.
• Patients should avoid contact lens wear until the abrasion is fully healed and follow-up within 24-48 hours is advised to ensure proper healing.
• Most corneal abrasions of this size heal within 24-72 hours with appropriate treatment, leveraging the corneal epithelium's remarkable regenerative capabilities 1.

Important Notes

• If symptoms worsen or don't improve within 48 hours, immediate reassessment is necessary to rule out infection or other complications.
• The use of prophylactic topical antibiotics following corneal abrasion has been shown to prevent ulceration when treatment is started within 24 hours of the abrasion, especially in high-risk patients such as those wearing contact lenses or with a history of trauma 1.
• Regular follow-up is crucial to monitor the healing process and to adjust the treatment plan as necessary, ensuring the best possible outcome in terms of morbidity, mortality, and quality of life.

From the Research

Treatment for Corneal Abrasion

• The recommended treatment for a 2 mm corneal abrasion includes symptomatic treatment, consisting of foreign body removal and analgesia with topical nonsteroidal anti-inflammatory drugs or oral analgesics 2, 3.
• Topical antibiotics may also be used to prevent infection, although the evidence for their effectiveness is limited 2, 3, 4.
• Patching is not recommended as it does not improve pain and may delay healing 2, 3.
• The use of topical cycloplegics is not beneficial for uncomplicated corneal abrasions 2, 3.

Diagnosis and Examination

• Diagnosis of corneal abrasion can be confirmed by visualizing the cornea under cobalt-blue filtered light after the application of fluorescein 2, 3.
• A thorough examination should be performed to exclude serious causes of eye pain, including penetrating injury, infective keratitis, and corneal ulcers 3.
• Foreign bodies should be carefully removed, if present 3.

Follow-up and Referral

• Follow-up may not be necessary for patients with small (4 mm or less), uncomplicated abrasions, normal vision, and resolving symptoms 3.
• Referral is indicated for any patient with symptoms that do not improve or worsen, a corneal infiltrate or ulcer, significant vision loss, or a penetrating eye injury 3.