From the Guidelines
The recommended treatment for a corneal abrasion includes topical antibiotic eye drops, such as fluoroquinolone drops, applied 4 times daily for 5-7 days to prevent infection, as well as pain management with oral analgesics like ibuprofen or acetaminophen. This approach is supported by the most recent guidelines, which emphasize the importance of preventing infection in patients with corneal abrasions, especially those who wear contact lenses or have a history of trauma 1.
Key Considerations
- Topical antibiotics should be prescribed to prevent acute bacterial keratitis in patients who wear contact lenses and present with a corneal abrasion, as well as in patients with corneal abrasion following trauma.
- A broad-spectrum topical antibiotic is recommended for any patient presenting with corneal abrasion to prevent not only bacterial infection but also fungal infection.
- Patients should avoid eye rubbing, wear sunglasses for photophobia relief, and may use preservative-free artificial tears for comfort.
- An eye patch is generally no longer recommended as it doesn't improve healing and may increase infection risk.
- Most corneal abrasions heal within 24-72 hours, and patients should seek immediate follow-up care if symptoms worsen, vision decreases, or if there's increasing pain, redness, or discharge, as these may indicate complications such as infection.
Additional Guidance
In cases where the corneal abrasion is caused by a contact lens, patients should discontinue lens wear until complete healing occurs and the eye is no longer red or irritated 1. The use of a bandage contact lens is not recommended due to the increased risk of secondary bacterial keratitis, unless necessary for the treatment of other conditions such as corneal edema or opacification, and should be accompanied by a topical prophylactic broad-spectrum antibiotic 1.
From the Research
Treatment Options for Corneal Abrasion
- The management of corneal abrasions typically involves a combination of treatments, including topical antibiotics, cycloplegics, and bandage contact lenses 2.
- For simple corneal abrasions, topical anesthetics such as proparacaine, tetracaine, or oxybuprocaine may be prescribed for use up to every 30 minutes as needed during the first 24 hours after presentation, with a maximum total dose of 1.5 to 2 mL 3.
- Bandage contact lenses have been shown to be an effective treatment modality for corneal abrasions, allowing for rapid return to duty and reducing morbidity in terms of pain and lost work time 4.
- Topical antibiotic alone or in combination with a cycloplegic is a common immediate treatment for corneal abrasions, while padding and patient follow-up are practiced by most units some of the time 5.
- The use of soft contact lenses and topical diclofenac has also been reported as an effective treatment for corneal abrasions, providing significant pain relief and allowing for rapid healing 6.
Considerations for Treatment
- Large and central corneal abrasions may warrant a consultation with a corneal specialist 2.
- Patients with undisclosed risk factors for corneal ulcers may not be suitable for treatment with bandage contact lenses 4.
- The use of topical anesthetics should be limited to simple corneal abrasions and should not exceed 24 hours, with any remainder discarded after 24 hours 3.