What is the treatment for corneal abrasion?

From the Guidelines

Treatment for corneal abrasion should prioritize pain management, prevention of infection, and promotion of healing, with a focus on topical antibiotics to prevent acute bacterial keratitis, especially in patients who wear contact lenses or have suffered trauma, as recommended by the most recent guidelines 1. The goal of treatment is to minimize the risk of complications, such as bacterial keratitis, and to promote rapid healing of the corneal epithelium.

• Pain relief can be achieved with oral analgesics like acetaminophen or ibuprofen, and topical anesthetic drops like proparacaine can be used for initial examination, but prolonged use should be avoided as it can delay healing 1.
• Topical antibiotics, such as erythromycin, polymyxin B/trimethoprim, or fluoroquinolones, should be prescribed to prevent infection, usually applied 4 times daily for 3-5 days, as they have been shown to prevent ulceration when started within 24 hours of the abrasion 1.
• 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, but their use should be judicious and based on individual patient needs 1.
• Eye patching is generally no longer recommended as it doesn't improve healing and may increase infection risk, especially in patients who wear contact lenses or have suffered trauma 1.
• Patients should avoid wearing contact lenses until the abrasion is fully healed and follow-up care is completed, and should be advised to seek immediate care if symptoms worsen, as this could indicate infection or complications 1. The most recent guidelines emphasize the importance of early detection and treatment to minimize permanent visual loss, and recommend that patients with risk factors predisposing them to bacterial keratitis should be educated about their increased risk and informed about the signs and symptoms of infection 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. The treatment for corneal abrasion may include bacitracin ophthalmic ointment if the abrasion is caused by a Bacitracin susceptible organism, as it is indicated for the treatment of superficial ocular infections involving the cornea 2.

• The ointment should be applied directly into the conjunctival sac
• Application frequency is 1 to 3 times daily 2.

From the Research

Treatment Overview

• The primary goals of treating corneal abrasions include pain control, prevention of infection, and promoting healing 3, 4.
• 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 3, 4, 5.
• Topical cycloplegics are not recommended for uncomplicated corneal abrasions 3.

Prevention of Infection

• Topical antibiotics may be prescribed to prevent bacterial superinfection, especially in contact lens-related abrasions 3, 4, 6.
• Antipseudomonal topical antibiotics are recommended for contact lens-related abrasions 3.

Healing and Follow-Up

• Patching is not recommended as it does not improve pain and may delay healing 3, 4, 7.
• 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 3.
• Referral to an ophthalmologist is indicated for patients with severe symptoms, corneal infiltrate or ulcer, significant vision loss, or penetrating eye injury 3, 7.

Alternative Treatments

• The use of soft contact lenses and topical diclofenac has been explored as an alternative to traditional patching for pain relief and healing 5.
• Dual drug-loaded coaxial nanofibers have shown potential as an ocular insert for the treatment of corneal abrasion, offering sustained release of antibiotics and anti-scarring agents 6.