What is the treatment for a corneal abrasion (eye scratch) in a family medicine setting?

Management of Corneal Abrasion in Family Medicine

For corneal abrasion treatment in family medicine, immediately irrigate the eye with tap water or commercial eyewash solution, apply antibiotic drops such as moxifloxacin 0.5%, and provide pain relief with oral analgesics. 1

Initial Assessment

• Determine mechanism of injury:
  • Low-energy (dust, dirt, eyelash): Can be managed in family medicine setting
  • High-velocity injury (grinding, nailing, machinery): Requires immediate referral 2
• Assess for red flags requiring immediate ophthalmology referral:
  • Penetrating eye injury from sharp/metal object
  • Irregular pupil after trauma
  • Eye bleeding
  • Vision loss after trauma
  • Foreign body sensation that persists despite treatment 2

Treatment Algorithm

Step 1: Foreign Body Removal

• Allow natural tears to wash out the object or irrigate with:
  • Tap water (effective and readily available) 2
  • Commercial eyewash solution if available 2
• Do NOT rub the eye as this can worsen the abrasion 2

Step 2: Infection Prevention

• Apply topical broad-spectrum antibiotic drops/ointment:
  • Preferred: Fluoroquinolones (moxifloxacin 0.5% or gatifloxacin 0.3%) 1
  • Alternative: Ciprofloxacin 0.3%, ofloxacin 0.3%, or levofloxacin 1.5% 1
• Apply 1 drop 4 times daily for 3-5 days

Step 3: Pain Management

• Oral analgesics:
  • Acetaminophen or NSAIDs 2, 1
• Preservative-free ocular lubricants every 2 hours for comfort 1
• Consider cycloplegic agents if significant pain from ciliary spasm 1

Step 4: Protective Measures

• Apply hard plastic eye shield, paper cup, or plastic cup over the eye to prevent touching 2
• Do NOT patch the eye - evidence shows patching:
  • Does not improve healing 3
  • May delay healing 1, 3
  • Increases risk of infection, especially in contact lens wearers 1, 3

Special Considerations

Contact Lens Wearers

• Remove contact lens immediately 1
• Do not wear contact lenses during treatment 1
• Higher risk of infection - monitor closely
• Reassess lens choice and fitting after healing 1

Follow-up Recommendations

• Small, uncomplicated abrasions (≤4 mm) with normal vision and resolving symptoms: No follow-up needed
• Larger or complicated abrasions: Re-evaluate within 24 hours 1
• Daily follow-up during acute phase for larger abrasions 1

Important Cautions

• Avoid topical anesthetics for outpatient use - delays healing and leads to complications 1
• Avoid topical corticosteroids in the presence of active infection 1
• Avoid bandage contact lens use due to increased risk of bacterial keratitis 1
• If no improvement after 48 hours, consider antibiotic resistance, incorrect diagnosis, or non-infectious cause 1

Prevention Education

• Recommend protective eyewear for sports and high-risk activities 1
• Educate patients about signs requiring prompt ophthalmology consultation:
  • Worsening symptoms
  • Development of corneal infiltrate or ulcer
  • Significant vision loss 1

By following this evidence-based approach, most corneal abrasions will heal within 24-72 hours without complications 4. The key principles are preventing infection, promoting healing, and minimizing pain while avoiding interventions that may delay healing or increase infection risk.