From the Guidelines
Treatment for corneal abrasion should include topical antibiotics to prevent infection, with a broad-spectrum topical antibiotic recommended for any patient presenting with corneal abrasion following trauma, as this helps prevent not only bacterial infection but also fungal infection. According to the most recent guidelines 1, prophylactic topical antibiotics following corneal abrasion has been shown to prevent ulceration when treatment is started within 24 hours of the abrasion.
Key Considerations
- Topical antibiotics should be prescribed to prevent acute bacterial keratitis in patients who wear contact lenses and present with a corneal abrasion.
- Patients with contact-lens associated abrasion should not have their eye patched or use a therapeutic contact lens due to concerns for increased risk of secondary bacterial keratitis 1.
- For pain relief, oral analgesics like acetaminophen or ibuprofen can be used, along with topical anesthetic drops (such as proparacaine) for initial examination only, as repeated use can delay healing.
- Cycloplegic drops like cyclopentolate 1% or homatropine 5% may be used to reduce pain from ciliary muscle spasm, typically 1-2 drops 2-3 times daily until pain resolves.
Management
- Patients should avoid wearing contact lenses until the abrasion heals completely and the prescribed medication course is finished.
- Eye patching is generally not recommended as it doesn't improve healing and may increase infection risk.
- Most corneal abrasions heal within 24-72 hours with proper treatment.
- Patients should be advised to seek immediate medical attention if symptoms worsen, vision deteriorates, or if there's increased redness, discharge, or light sensitivity, as these could indicate complications like infection. The guidelines from 1 provide the most recent and highest quality evidence for the treatment of corneal abrasion, and should be followed to prioritize morbidity, mortality, and quality of life as the outcome.
From the FDA Drug Label
INDICATIONS AND USAGE: For the treatment of superficial ocular infections involving the conjunctiva and/or cornea caused by Bacitracin susceptible organisms. The treatment for corneal abrasion may involve antibiotic ointment such as bacitracin, but only if the abrasion is caused by a bacitracin susceptible organism.
- The ointment should be applied 1 to 3 times daily directly into the conjunctival sac 2.
- It is essential to follow proper application and hygiene procedures to avoid contamination of the ointment 2.
From the Research
Treatment Options for Corneal Abrasion
- The treatment of corneal abrasion may involve the use of antibiotic ointment and pressure patching 3.
- Alternatively, a bandage contact lens and topical nonsteroidal anti-inflammatory drugs (NSAIDs) such as diclofenac or ketorolac may be used to provide pain relief and promote healing 4, 5, 6.
- A study comparing three different treatment modalities (pressure patching, therapeutic contact lens, and ointment alone) found no significant difference in the reduction of corneal abrasion area or pain relief 7.
Medications Used in Treatment
- Topical antibiotics such as chloramphenicol and fusidic acid may be used to prevent infection 3.
- Topical NSAIDs such as ketorolac and diclofenac may be used to reduce pain and inflammation 5, 6.
- The use of topical antibiotics and NSAIDs may be beneficial in promoting healing and reducing pain, but the current evidence is limited and more research is needed to determine the most effective treatment regimen 3, 5, 6.
Contact Lenses in Treatment
- Bandage contact lenses may be used to protect the cornea and promote healing 4, 6, 7.
- The use of a bandage contact lens with a topical NSAID may provide significant pain relief and reduce the time required for a patient to return to normal activities 6.
- Therapeutic contact lenses may be an effective adjunct in treating traumatic corneal abrasions, but more research is needed to determine their effectiveness compared to other treatment modalities 7.