What is the treatment for corneal abrasion?

From the Guidelines

Treatment for a 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.

Key Components of Treatment

• Pain relief: Oral analgesics like acetaminophen or ibuprofen, along with topical NSAIDs such as ketorolac 0.5% drops four times daily.
• Prevention of infection: Topical antibiotics, commonly erythromycin ointment or fluoroquinolone drops like moxifloxacin or ciprofloxacin, applied 4 times daily for 5-7 days, are crucial in preventing bacterial keratitis, particularly in high-risk patients 1.
• Promotion of healing: Cycloplegic drops such as cyclopentolate 1% or homatropine 5% may be used to reduce pain from ciliary muscle spasm, typically 1-2 drops 2-3 times daily for 1-2 days.

Important Considerations

• Patients should avoid wearing contact lenses until the abrasion is fully healed and the prescribed medication course is completed.
• Eye patching is no longer routinely recommended as it doesn't improve healing and may increase infection risk, especially in cases of contact lens-associated abrasions or trauma 1.
• Most corneal abrasions heal within 24-72 hours with proper treatment.
• Patients should be advised to seek immediate medical attention if symptoms worsen, vision deteriorates, or if there's increasing pain, redness, or discharge, as these could indicate complications like infection.

Additional Guidance

• The use of prophylactic topical antibiotics following corneal abrasion has been shown to prevent ulceration when treatment is started within 24 hours of the abrasion, highlighting the importance of prompt treatment 1.
• In cases where there's a high risk of infection, such as with contact lens wear or trauma, the use of broad-spectrum topical antibiotics is recommended to prevent not only bacterial but also fungal infections 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 the ointment should be as directed by the physician, typically applying the ointment directly into the conjunctival sac 1 to 3 times daily 2 2.
• It is essential to note that the treatment should be guided by the specific cause of the corneal abrasion and the susceptibility of the causative organism to the antibiotic.
• Patients should be instructed to take appropriate measures to avoid gross contamination of the ointment when applying it directly to the infected eye 2.

From the Research

Treatment for Corneal Abrasion

The treatment for corneal abrasion typically involves symptomatic relief and prevention of infection. The following are some of the treatment options:

• Foreign body removal and analgesia with topical nonsteroidal anti-inflammatory drugs or oral analgesics 3, 4
• Topical antibiotics may be used to prevent bacterial superinfection 3, 4
• Contact lens-related abrasions should be treated with antipseudomonal topical antibiotics 4
• Bandage contact lenses may be used as an alternative to pressure patching in the treatment of corneal abrasions 5, 6
• Topical cycloplegics are not recommended for uncomplicated corneal abrasions 4
• Patching is not recommended as it does not improve pain and has the potential to delay healing 3, 4

Goals of Treatment

The goals of treatment for corneal abrasion include:

• Pain control
• Prevention of infection
• Healing 4

Follow-up and Referral

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. Referral 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 4