From the Guidelines
Management of a corneal abrasion involves a comprehensive approach beginning with pain control and antibiotic prophylaxis to prevent infection, and typically does not involve patching due to increased risk of secondary bacterial keratitis. The most recent and highest quality study, 1, recommends topical antibiotics to prevent acute bacterial keratitis in patients who wear contact lenses and present with a corneal abrasion, as well as in patients with a corneal abrasion following trauma. This approach helps prevent not only bacterial infection but also fungal infection.
Key components of management include:
- Pain control using topical NSAIDs like ketorolac 0.5% drops four times daily for 3-5 days
- Antibiotic prophylaxis with erythromycin 0.5% ointment or fluoroquinolone drops such as moxifloxacin 0.5% four times daily for 5-7 days, as supported by 1
- Cycloplegic agents like cyclopentolate 1% or homatropine 2% to reduce ciliary spasm and provide comfort
- Oral analgesics such as acetaminophen or ibuprofen to supplement pain management
- Avoidance of contact lens wear until complete healing occurs
- Follow-up within 24-48 hours, as most corneal abrasions heal within 24-72 hours with appropriate treatment, according to 1
It is essential to advise patients to return immediately if symptoms worsen, as this could indicate infection or complications. The corneal epithelium has remarkable regenerative capacity, with cells migrating from the periphery to cover the defect, followed by cell proliferation and adhesion to restore the protective barrier.
From the Research
Corneal Abrasion Presentation
The presentation of a corneal abrasion typically includes symptoms such as foreign body sensation, tearing, and sensitivity to light, often following a history of trauma 2.
Management of Corneal Abrasion
The management of corneal abrasion involves several key components:
- Pain control: This can be achieved with topical nonsteroidal anti-inflammatory drugs or oral analgesics 2. Topical diclofenac has been shown to reduce pain in patients with corneal abrasions 3.
- Prevention of infection: Although evidence is lacking, topical antibiotics are commonly prescribed to prevent bacterial superinfection 2. Contact lens-related abrasions should be treated with antipseudomonal topical antibiotics 2.
- Healing: The goals of treatment also include promoting healing of the corneal abrasion 2.
- Follow-up: Follow-up may not be necessary for patients with small (4 mm or less), uncomplicated abrasions; normal vision; and resolving symptoms. All other patients should be reevaluated in 24 hours 2.
Treatment Options
Treatment options for corneal abrasion include:
- Topical antibiotics, such as chloramphenicol or fusidic acid 4
- Topical nonsteroidal anti-inflammatory drugs 2
- Oral analgesics 2
- Antimicrobial prophylaxis 5
Referral to Specialist
Referral to a specialist is indicated for any patient with symptoms that do not improve or that worsen, a corneal infiltrate or ulcer, significant vision loss, or a penetrating eye injury 2. Persistent, worsening, or new symptoms also warrant immediate specialist consultation 5.