Follow-Up Schedule for Corneal Abrasions
Patients with corneal abrasions should be re-evaluated within 24 hours if they have large (>2mm), central, or complicated abrasions, while small (<4mm), uncomplicated abrasions with resolving symptoms may not require follow-up. 1
Initial Assessment and Risk Stratification
When determining the appropriate follow-up schedule for corneal abrasions, consider these key factors:
- Size of abrasion: Abrasions >2mm require closer follow-up
- Location: Central abrasions affecting visual axis need more monitoring
- Etiology: Contact lens-related or traumatic abrasions have higher infection risk
- Symptoms: Worsening pain, decreased vision, or increased redness warrant immediate re-evaluation
Follow-Up Schedule Algorithm
Low-Risk Abrasions (Can Consider No Follow-Up)
- Small (≤4mm) peripheral abrasions
- No contact lens history
- Normal vision
- Resolving symptoms
- No signs of infection
Standard Follow-Up (24 Hours)
- Most corneal abrasions should be re-evaluated within 24 hours 1
- Particularly important for:
- Contact lens wearers
- Central or large (>2mm) abrasions
- Significant pain or visual symptoms
- Traumatic abrasions
Urgent Follow-Up (Same Day)
- Worsening symptoms despite treatment
- Development of infiltrate or ulcer
- Significant vision loss
- Signs of infection (increasing pain, purulent discharge)
Treatment Considerations Affecting Follow-Up
- Antibiotic prophylaxis: Topical antibiotics should be prescribed for contact lens-related abrasions or those following trauma to prevent bacterial keratitis 1
- No patching: Patching is not recommended as it does not improve healing and may increase infection risk, especially in contact lens wearers 2
- Pain management: Topical NSAIDs or oral analgesics may be used for pain control 3
Special Considerations
Contact Lens Wearers
- Higher risk for infection, particularly Pseudomonas
- Require antipseudomonal antibiotics
- Should be seen within 24 hours
- Must discontinue contact lens wear until complete healing
Bandage Contact Lens Use
- If a bandage contact lens is used for comfort, more frequent follow-up is necessary
- Regular assessment of the lens fit and ocular status is required
- Patient should be informed about infection risk despite antibiotic use 1
When to Refer to Ophthalmology
- Symptoms that worsen or don't improve
- Development of corneal infiltrate or ulcer
- Significant vision loss
- Penetrating eye injury
- Large or central abrasions affecting vision
Common Pitfalls to Avoid
- Inadequate follow-up: Failing to re-evaluate high-risk abrasions can lead to missed infections
- Overuse of patching: Patching delays healing and increases infection risk 2
- Insufficient antibiotic coverage: Contact lens-related abrasions require broader coverage
- Missing foreign bodies: Always thoroughly examine for retained foreign bodies
- Delayed referral: Progressive symptoms warrant prompt ophthalmology evaluation
Most corneal abrasions heal within 24-72 hours with appropriate treatment 4, but proper follow-up is essential to ensure complete healing and prevent complications like bacterial keratitis or recurrent erosion syndrome 5.