From the Guidelines
Minor corneal abrasions should be treated with topical antibiotics to prevent infection, and pain management should be provided, while avoiding eye patching due to the increased risk of infection. The treatment guidelines for minor corneal abrasions prioritize the prevention of infection and the management of pain to ensure the best possible outcome in terms of morbidity, mortality, and quality of life.
Key Considerations
- Topical antibiotics such as erythromycin ointment, polymyxin B/trimethoprim drops, or fluoroquinolones like ciprofloxacin or moxifloxacin are recommended for antibiotic prophylaxis, usually applied 4 times daily for 3-5 days 1.
- Pain can be managed with oral analgesics like acetaminophen or ibuprofen, and cycloplegic drops 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 heals completely and the prescribed medication course is finished.
- Eye patching is not recommended as it does not improve healing and may increase the risk of infection, especially in patients who wear contact lenses or have suffered trauma 1.
Important Recommendations
- Regular follow-up is necessary to reassess the patient’s ocular status and to re-emphasize the need for patient vigilance.
- Patients should be informed of the risk of infectious keratitis and the need to contact their treating ophthalmologist if redness, pain, or increased photophobia develops.
- The use of topical antibiotics does not eliminate the risk of infectious keratitis, and this risk may be greater in patients with chronic ocular surface disease 1.
Recent Guidelines
- The most recent guidelines from 2024 emphasize the importance of topical antibiotics in preventing acute infection in patients with a corneal abrasion who wear contact lenses or have suffered trauma 1.
- These guidelines also highlight the increased resistance of methicillin-resistant Staphylococcus aureus (MRSA) and Pseudomonas aeruginosa to topical fluoroquinolones, which should be considered when selecting antibiotic therapy.
From the Research
Treatment Guidelines for Minor Corneal Abrasions
The recommended treatment for minor corneal abrasions includes:
- Symptomatic treatment, consisting of foreign body removal and analgesia with topical nonsteroidal anti-inflammatory drugs (NSAIDs) or oral analgesics 2, 3, 4, 5
- Topical antibiotics may be used to prevent infection, especially in contact lens-related abrasions 2, 3
- Eye patching is not recommended as it does not improve pain and may hinder healing 2, 3
- Topical mydriatics and cycloplegics are not beneficial for uncomplicated corneal abrasions 2, 3
Pain Management
Pain relief can be achieved with:
- Topical NSAIDs, such as ketorolac trometamol 0.5% ophthalmic solution 5
- Oral analgesics 2, 3
- Topical diclofenac (Voltaren) eye drops, in combination with a disposable soft contact lens 6
Follow-up and Referral
- Patients with small, uncomplicated abrasions and resolving symptoms may not require follow-up 3
- All other patients should be reevaluated in 24 hours 3
- Referral is indicated for patients with symptoms that do not improve or worsen, corneal infiltrate or ulcer, significant vision loss, or penetrating eye injury 3