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 ophthalmic 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 agents such as cyclopentolate 1% or homatropine 5% may be used to reduce pain from ciliary muscle spasm
- Patients should avoid wearing contact lenses until the abrasion is fully healed and the eye is no longer red
- A protective eye patch may be used for comfort, though evidence for its effectiveness is mixed
- Most corneal abrasions heal within 24-72 hours with proper treatment, and patients should follow up with an eye care professional if symptoms worsen or don't improve within 2-3 days 1.
It's also important to note that 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, but should be avoided in cases of suspected Acanthamoeba, Nocardia, or fungus 1.
From the Research
Treatment Overview
- The primary goals of treating corneal abrasions include pain control, prevention of infection, and promotion of healing 2, 3.
- 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 2, 3.
- The use of topical anesthetics for simple corneal abrasions has been reassessed, suggesting it may be safe when used appropriately and in limited quantities 4.
Prevention of Infection
- Topical antibiotics are often prescribed to prevent bacterial superinfection, although evidence for their effectiveness is limited 2, 3.
- For contact lens-related abrasions, antipseudomonal topical antibiotics are recommended 2.
Healing and Follow-Up
- Patching is not recommended as it does not improve pain and may delay healing 2, 3.
- Small, uncomplicated abrasions may not require follow-up, but patients with larger abrasions, significant vision loss, or worsening symptoms should be reevaluated within 24 hours 2.
- Innovative treatments, such as dual drug-loaded coaxial nanofibers, are being explored for their potential in treating corneal abrasions with improved efficacy and reduced dosing frequency 5.