What is the treatment for corneal abrasion?

Treatment for Corneal Abrasion

The standard treatment for corneal abrasion includes topical broad-spectrum antibiotics, pain management with oral analgesics or topical NSAIDs, and avoiding eye patching as it does not improve healing and may increase infection risk. 1

Initial Management

Antibiotic Prophylaxis

• Apply topical broad-spectrum antibiotics to prevent secondary infection 1
  • Options include:
    • Moxifloxacin 0.5% or gatifloxacin 0.3% for broad-spectrum coverage
    • Bacitracin ointment applied 1-3 times daily directly into the conjunctival sac 2
    • Erythromycin ointment (can be substituted with bacitracin if not available) 1

Pain Management

• Oral analgesics (acetaminophen, NSAIDs) for pain relief 1
• Topical NSAIDs significantly reduce pain scores at 24 and 48 hours and decrease need for oral analgesics by 53% 3
• Avoid topical anesthetics for outpatient use as they can delay healing and lead to complications 1

What NOT to Do

• Do not patch the eye - evidence shows it does not improve healing and may increase infection risk 1, 4, 5
• Do not use topical cycloplegics for uncomplicated corneal abrasions as evidence does not support their use 5

Wound Care

• Irrigate the eye with tap water or commercial eyewash solution 1
• Remove any foreign bodies if present 5
• Avoid rubbing the eye as it can worsen the abrasion 1
• For contact lens wearers:
  • Remove contact lens immediately 1
  • Do not wear contact lenses during treatment 1
  • Use antipseudomonal topical antibiotics for contact lens-related abrasions 5

Special Considerations

• For delayed healing:
  • Consider bandage contact lens (BCL) 6, 1
  • Amniotic membrane may be helpful in cases of delayed healing 6
  • BCLs should not remain on the eye for longer than one month 1

Follow-up

• 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
• Most corneal abrasions heal within 24-72 hours 4

When to Refer

• Symptoms that do not improve or worsen
• Development of corneal infiltrate or ulcer
• Significant vision loss
• Penetrating eye injury 5
• High-velocity injuries (e.g., grinding, nailing, machinery) require immediate referral 1

Prevention

• Recommend protective eyewear for sports and high-risk activities 1
• Avoid overnight wear of contact lenses 1

While the Cochrane review notes limited high-quality evidence regarding antibiotic prophylaxis for corneal abrasions 7, standard clinical practice continues to include topical antibiotics to prevent secondary infection 1. The primary goals of treatment are pain control, prevention of infection, and promotion of healing.