What is the treatment for a conjunctival abrasion?

Treatment of Conjunctival Abrasion

Broad-spectrum topical antibiotics should be applied to prevent infection in all patients with conjunctival abrasions. 1

Initial Management

• Cleaning and Assessment:

  • Carefully clean the affected eye with sterile saline solution
  • Perform complete ophthalmological evaluation to determine extent of laceration, presence of foreign bodies, and signs of infection 1

• Antibiotic Therapy:

  • Apply broad-spectrum topical antibiotic ointment 2-3 times daily for 5-7 days 1
  • Options include:
    • Bacitracin ointment 1-3 times daily 2
    • Erythromycin ointment 3
    • Fluoroquinolones (for more severe cases)

• Supportive Care:

  • Lubricating eye drops to maintain a humid ocular surface and promote healing 1
  • Oral analgesics (acetaminophen or NSAIDs) for pain management
  • Avoid topical anesthetics except for initial evaluation 1

Special Considerations

• Contact Lens Wearers:

  • Avoid patching or using therapeutic contact lens due to increased risk of secondary bacterial keratitis 4
  • Topical antibiotics should be prescribed to prevent acute bacterial keratitis 4

• Traumatic Abrasions:

  • Broad-spectrum topical antibiotic is recommended for any patient presenting with corneal abrasion following trauma 4
  • Prophylactic topical antibiotics following corneal abrasion has been shown to prevent ulceration when started within 24 hours of the abrasion 4

Surgical Intervention

• Surgical repair with fine absorbable sutures (6-0 or 7-0) is recommended for:
  • Extensive lacerations
  • Significant scleral exposure
  • Risk of abnormal scarring
  • Involvement of the conjunctival fornices 1

Follow-up Care

• Reevaluation should be performed in 24-48 hours for simple cases
• Daily follow-up for more severe cases until complete resolution 1
• Monitor for:
  • Signs of infection
  • Adequate healing
  • Development of complications (symblepharon, excessive scarring) 1

Potential Complications

• Secondary infection
• Abnormal scarring with symblepharon formation
• Subepithelial fibrosis
• Alterations in the ocular surface
• Secondary dry eye syndrome 1

Prevention

• Use proper eye protection during high-risk activities
• Maintain good hand hygiene to prevent secondary infections
• Avoid rubbing eyes during the healing period 1

Important Caveats

• While some clinicians prefer not to use antibiotics due to concerns about bacterial resistance, drug toxicity, and cost, the evidence supports their use to prevent infection 4
• The efficacy of specific antibiotic regimens over others remains unclear based on current evidence 5
• Disposable soft contact lenses combined with antibiotic drops may provide pain relief while allowing binocular vision, but should be used with caution due to infection risk 6
• Antibiotic drops placed in the conjunctival cul-de-sac appear to be as effective as ointment applied to the lid margins in reducing bacterial colonization 7