What eye drop should be used to treat a corneal abrasion?

Eye Drop Treatment for Corneal Abrasion

For corneal abrasions, prescribe a topical antibiotic (fluoroquinolone or polymyxin B/bacitracin) to prevent secondary bacterial infection, particularly in contact lens wearers or trauma cases. 1

Primary Treatment: Topical Antibiotics

The 2024 AAO Bacterial Keratitis Guidelines provide clear direction: topical antibiotics should be prescribed to prevent acute infection in patients with corneal abrasions who wear contact lenses or suffered trauma 1. This is a strong recommendation based on the significant risk of bacterial keratitis in these populations.

Antibiotic Selection

• Fluoroquinolones (moxifloxacin, gatifloxacin) are first-line for contact lens-related abrasions due to Pseudomonas coverage
• Polymyxin B/bacitracin or erythromycin ointment are acceptable alternatives for non-contact lens trauma 2, 3
• Note: Increasing fluoroquinolone resistance in MRSA and Pseudomonas has been documented from 2005-2015 1

Critical caveat: Do NOT patch the eye in contact lens wearers or trauma cases, as this increases the risk of secondary bacterial keratitis 1

Adjunctive Pain Management: NSAIDs

Topical NSAIDs (ketorolac 0.5% or diclofenac) provide superior pain relief and should be considered as adjunctive therapy for patient comfort 4, 2, 5.

Evidence for NSAIDs:

• Ketorolac significantly reduced pain, photophobia, and foreign body sensation at 24 hours (p<0.002) 2
• Diclofenac showed 2.1-point greater improvement on pain scales compared to placebo at 2 hours 4
• NSAIDs allowed 80% of patients to return immediately to normal activities 5
• No complications or delayed healing were observed with NSAID use 4, 2, 5

Controversial: Topical Anesthetics

Avoid prescribing topical anesthetics (tetracaine, proparacaine) for outpatient use despite recent research suggesting short-term safety. While a 2014 study showed no complications with 24-hour tetracaine use 6, the most recent 2026 data demonstrates 1.81-fold increased ED readmission rates (RR 1.81, RD 2.99%) in patients prescribed topical anesthetics 7. This represents real-world evidence of harm that outweighs the theoretical pain benefit.

The ophthalmology community maintains strong concerns about epithelial toxicity, corneal melting, and delayed healing with topical anesthetic use 8, 7, 9. This is an area where guideline recommendations and recent high-quality observational data align against a practice that some emergency medicine literature has promoted.

Additional Considerations

Cycloplegics

• Consider cycloplegic drops (cyclopentolate, homatropine) for photophobia relief in moderate-to-large abrasions
• Reduces ciliary spasm pain

Bandage Contact Lenses

• May be used in select cases for comfort and healing 5
• Requires close ophthalmology follow-up
• Not appropriate for contact lens-related abrasions due to infection risk

Follow-up

Ophthalmology follow-up within 30 days is protective and reduces readmission risk (RR 0.82) 7, particularly important if prescribing any controversial therapies or if the abrasion is large, central, or not improving within 24-48 hours.

Treatment Algorithm

1. Confirm diagnosis with fluorescein staining and exclude penetrating injury
2. Prescribe topical antibiotic (mandatory for contact lens wear or trauma)
3. Add topical NSAID for pain control (ketorolac or diclofenac QID)
4. Consider cycloplegic if significant photophobia
5. Avoid eye patching in at-risk patients
6. Do NOT prescribe topical anesthetics for home use
7. Arrange ophthalmology follow-up within 24-48 hours for large/central abrasions or within 30 days for routine cases