What is the management for corneal abrasion?

Management of Corneal Abrasion

The management of corneal abrasion should include topical antibiotics, pain control with oral analgesics or topical NSAIDs, and avoidance of eye patching, as patching does not improve healing and may increase infection risk. 1

Initial Assessment and Treatment

Antibiotic Prophylaxis

• Use topical antibiotics to prevent secondary infection:
  • For non-contact lens wearers: Broad-spectrum antibiotics such as moxifloxacin 0.5% or gatifloxacin 0.3% 1
  • For contact lens wearers: Antipseudomonal coverage is essential due to higher risk of Pseudomonas infection 1

Pain Management

• Options include:
  • Oral analgesics (NSAIDs or acetaminophen) 1
  • Topical NSAIDs (e.g., diclofenac) can provide significant pain relief 1, 2
  • Preservative-free ocular lubricants every 2 hours to promote comfort 1
  • Cycloplegic agents when anterior chamber inflammation is present to reduce ciliary spasm 1

Important Interventions to Avoid

• Do not patch the eye - Multiple well-designed studies show patching does not help and may delay healing 1, 3, 4
• Avoid topical anesthetics for outpatient use as they delay healing 1
• Do not use topical corticosteroids in the presence of active infection without antibiotic coverage 1

Special Considerations

Contact Lens Wearers

• Remove contact lens immediately to prevent further irritation 1
• Patients should not wear contact lenses during treatment 1
• Reassess lens choice and fitting after healing 1
• Consider bandage contact lens only in cases of delayed healing, but be aware of increased risk of bacterial keratitis 5, 1

For Persistent or Complicated Abrasions

• Amniotic membrane may be helpful in cases of delayed healing 5
• For progressive thinning or small perforations:
  • Apply tissue adhesive (cyanoacrylate) over a clean, dry base 5, 1
  • Adhesive may remain in place for 6+ weeks if applied properly 5
  • Avoid fibrin glue due to rapid biodegradation 1

Follow-up Recommendations

• Small, uncomplicated abrasions (≤4 mm) with normal vision and resolving symptoms may not need follow-up 4
• All other patients should be reevaluated within 24 hours 1, 4
• Daily follow-up during the acute phase for larger or complicated abrasions 1
• Monitor for:
  • Complete re-epithelialization
  • Decrease in anterior chamber reaction
  • Resolution of pain and redness 1

When to Refer

• Symptoms that worsen or don't improve
• Development of corneal infiltrate or ulcer
• Significant vision loss
• Suspicion of penetrating eye injury 4, 6
• No improvement after 48 hours (consider antibiotic resistance or incorrect diagnosis) 1

Prevention

• Recommend protective eyewear for sports and high-risk activities 1, 3
• Educate patients about signs and symptoms requiring prompt consultation 1

Most corneal abrasions heal within 24-72 hours with appropriate management 3. The current evidence regarding the superiority of one antibiotic regimen over another remains unclear, but prophylactic antibiotics are commonly prescribed to prevent bacterial superinfection 7, 4.