What is the treatment for corneal abrasion?

From the Guidelines

Treatment for corneal abrasion should include topical antibiotics to prevent infection, particularly in patients who wear contact lenses or have suffered trauma, as well as pain management and promotion of healing. The use of topical antibiotics is crucial in preventing acute bacterial keratitis, and broad-spectrum topical antibiotics are recommended for any patient presenting with corneal abrasion following trauma 1. For pain relief, oral analgesics like acetaminophen or ibuprofen can be used, along with topical NSAIDs such as ketorolac 0.5% drops four times daily.

Some key considerations in the treatment of corneal abrasion include:

• The use of prophylactic topical antibiotics in patients with chronic epithelial defects is controversial, as chronic use may promote the growth of resistant organisms 1
• Patching the eye or using a therapeutic contact lens is not advised in patients with contact-lens associated abrasion due to concerns for increased risk of secondary bacterial keratitis 1
• Cycloplegic drops like cyclopentolate 1% or homatropine 5% may be used to reduce pain from ciliary muscle spasm, typically 1-2 drops twice daily for 1-2 days
• Patients should avoid wearing contact lenses until the abrasion heals completely and the prescribed medication course is finished
• Most corneal abrasions heal within 24-72 hours with proper treatment, and patients should be advised to seek immediate medical attention if symptoms worsen, as this could indicate infection or complications 1.

It is essential to note that the majority of community-acquired cases of bacterial keratitis that are small noncentral ulcers resolve with topical empiric therapy, but smears and/or cultures are specifically indicated in certain circumstances 1. Additionally, the efficacy of the therapeutic regimen is judged primarily by the clinical response, and corticosteroids may be considered after 48 hours of antibiotic therapy when the causative organism is identified and/or the infection has responded to therapy 1.

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. INDICATIONS AND USAGE For the treatment of superficial ocular infections involving the conjunctiva and/or cornea caused by organisms susceptible to erythromycin.

The treatment for corneal abrasion may involve topical antibiotics such as bacitracin or erythromycin, but only if the abrasion is caused by a susceptible organism.

• The dosage and administration of bacitracin ointment is 1 to 3 times daily, applied directly into the conjunctival sac 2 2.
• Erythromycin is also used for the treatment of superficial ocular infections involving the conjunctiva and/or cornea caused by organisms susceptible to erythromycin 3. However, it is essential to note that the provided drug labels do not explicitly mention corneal abrasion as an indication, but rather superficial ocular infections.

From the Research

Treatment Overview

• The primary goals of treating corneal abrasions include pain control, prevention of infection, and promotion of healing 4, 5.
• Treatment approaches may vary depending on the severity and cause of the abrasion.

Pain Management

• Topical nonsteroidal anti-inflammatory drugs (NSAIDs) or oral analgesics are commonly used for pain relief 4, 5.
• The use of topical anesthetics for simple corneal abrasions has been reassessed, suggesting it may be safe when used appropriately and in limited quantities 6.

Prevention of Infection

• Topical antibiotics are often prescribed to prevent bacterial superinfection, although evidence for their effectiveness is limited 4, 5.
• For contact lens-related abrasions, antipseudomonal topical antibiotics are recommended 4.

Healing and Follow-Up

• Most corneal abrasions heal within 24 to 72 hours without complications 5.
• Patching is not recommended as it does not improve pain and may delay healing 4, 5.
• Follow-up may not be necessary for patients with small, uncomplicated abrasions and resolving symptoms, but others should be reevaluated in 24 hours 4.

Alternative and Emerging Treatments

• The use of soft contact lenses and topical diclofenac has been explored as an alternative to traditional patching, offering significant pain relief and allowing for binocular vision 7.
• Research into dual drug-loaded coaxial nanofibers for the treatment of corneal abrasion shows potential for once-daily dosing as an ocular insert, combining antimicrobial and anti-scarring properties 8.