What is the treatment for corneal abrasion?

Treatment of Corneal Abrasion

Topical antibiotics should be prescribed to prevent acute bacterial keratitis in patients with corneal abrasions, particularly in those with contact lens-related injuries. 1

Initial Management

Pain Control

• Oral analgesics:
  • Acetaminophen or NSAIDs for pain management 1, 2
  • Avoid rubbing the eye as this can worsen the injury 1

Medication Management

• Topical antibiotics (first-line treatment):

  • Broad-spectrum fluoroquinolones (moxifloxacin 0.5% or gatifloxacin 0.3%) 2
  • Fourth-generation fluoroquinolones have better gram-positive coverage 2
  • For small, non-central abrasions: ciprofloxacin 0.3%, ofloxacin 0.3%, or levofloxacin 1.5% 2
  • Bacitracin ophthalmic for superficial ocular infections 3

• Cycloplegic agents:

  • Consider when substantial anterior chamber inflammation is present 1, 2
  • Helps decrease pain and prevent synechiae formation 1

• Ocular lubricants:

  • Preservative-free lubricants every 2 hours to promote comfort 2

What NOT to Do

• Avoid patching:

  • Eye patching does not improve healing and may delay it 4, 5
  • Especially contraindicated in contact lens wearers due to increased risk of bacterial keratitis 1, 2

• Avoid topical anesthetics for outpatient use:

  • Can delay healing and lead to complications 2

• Avoid topical corticosteroids:

  • Should not be used in the presence of active infection without antibiotic coverage 2
  • May be considered only after 24-48 hours when infection is responding to therapy 1
  • Should be avoided with certain organisms like Acanthamoeba, Nocardia, and fungus 1

Special Considerations

Contact Lens Wearers

• Remove contact lens immediately 1
• Discontinue contact lens use during treatment 2
• Avoid bandage contact lens use due to increased risk of bacterial keratitis 1
• Require antipseudomonal topical antibiotics 5

Severe Cases

• For central or severe keratitis:
  • Initial loading dose applied every 5-15 minutes followed by hourly application 2
  • Consider fortified antibiotics (cefazolin 5% and tobramycin 1.3%) for large/visually significant infiltrates 2

Follow-Up Recommendations

• Small (≤4 mm), uncomplicated abrasions with normal vision and resolving symptoms may not require follow-up 5
• All other patients should be reevaluated in 24 hours 5
• Daily follow-up during acute phase to assess:
  • Healing progress
  • Reduction in infiltrate size
  • Re-epithelialization
  • Decrease in anterior chamber reaction
  • Resolution of pain and redness 2

When to Seek Immediate Medical Attention

• Symptoms that worsen or don't improve 5
• Development of corneal infiltrate or ulcer 5
• Significant vision loss 5
• Penetrating eye injury 5
• No improvement after 48 hours of treatment 2

Prevention

• Protective eyewear for sports and high-risk activities 1
• Early detection and appropriate treatment to minimize permanent visual loss 1
• Patient education about signs and symptoms requiring prompt consultation 1

While evidence regarding the efficacy of antibiotic prophylaxis remains of low to very low certainty 6, current guidelines from the American Academy of Ophthalmology still recommend topical antibiotics to prevent secondary infection, particularly in contact lens-related abrasions 1, 2.