What is the management of corneal abrasion?

Management of Corneal Abrasion

Corneal abrasions should be treated with topical broad-spectrum antibiotics, oral analgesics, and without eye patching, while avoiding topical anesthetics for outpatient use. 1

Initial Assessment and Treatment

• Red Flags Requiring Immediate Ophthalmology Referral:

  • Penetrating eye injury
  • Irregular pupil after trauma
  • Eye bleeding
  • Vision loss after trauma
  • Persistent foreign body sensation
  • High-velocity injuries (grinding, nailing, machinery) 1

• Immediate Management:

  1. Irrigate the eye with tap water or commercial eyewash solution
  2. Avoid rubbing the eye as it can worsen the abrasion
  3. Apply a hard plastic eye shield, paper cup, or plastic cup over the eye to prevent touching 1

Medication Management

Antibiotics

• Apply topical broad-spectrum antibiotic drops or ointment within 24 hours of injury 1

  • Preferred options:
    • Moxifloxacin 0.5% drops
    • Gatifloxacin 0.3% drops
    • Ciprofloxacin 0.3% drops
    • Ofloxacin 0.3% drops
    • Erythromycin or bacitracin ointment

• Contact lens-related abrasions require antipseudomonal coverage 2

• Prophylactic antibiotics are recommended to prevent secondary infection, though the Cochrane review notes limited high-quality evidence supporting this practice 1, 3

Pain Management

• Oral analgesics: Acetaminophen or NSAIDs for pain relief 1
• Topical NSAIDs (e.g., ketorolac 0.5%) can be considered for pain management and may reduce the need for oral analgesics 1, 4
• Avoid topical anesthetics for outpatient use as they delay healing and can lead to complications 1

Important Do's and Don'ts

Do's:

• Remove any foreign body if present
• Consider daily follow-up for larger or complicated abrasions
• Monitor for complete re-epithelialization
• Recommend protective eyewear for future prevention 1

Don'ts:

• Don't patch the eye - evidence shows it does not improve healing and may increase infection risk 1, 5, 2
• Don't use topical corticosteroids in the presence of active infection without antibiotic coverage 1
• Don't allow contact lens wear during treatment period 1
• Don't use topical cycloplegics for uncomplicated corneal abrasions 2

Special Considerations

Contact Lens Wearers

• Remove contact lens immediately
• Use antipseudomonal antibiotics
• Reassess lens choice and fitting after healing
• Advise against overnight wear of contact lenses 1

For Delayed Healing

• Consider bandage contact lens (with awareness of increased bacterial keratitis risk)
• Consider amniotic membrane in severe cases
• For progressive thinning or small perforations, apply tissue adhesive (cyanoacrylate) 1

Follow-up Recommendations

• Small (≤4 mm), uncomplicated abrasions with normal vision and resolving symptoms may not require follow-up
• All other patients should be reevaluated in 24 hours 2
• Refer to ophthalmology if symptoms worsen, corneal infiltrate or ulcer develops, significant vision loss occurs, or there's suspicion of penetrating eye injury 2

Most corneal abrasions heal within 24-72 hours with appropriate treatment 5. The American Academy of Ophthalmology guidelines emphasize that proper initial management is crucial to prevent complications such as infection, delayed healing, and permanent visual impairment 1.