What are the recommended treatments for an inner eyelid abrasion?

Treatment for Inner Eyelid Abrasion

For inner eyelid abrasions, the recommended treatment is topical broad-spectrum antibiotic drops or ointment combined with eyelid occlusion using adhesive strips to promote healing and prevent infection. 1, 2

Primary Treatment Components

1. Topical Antibiotics

• Apply a broad-spectrum antibiotic to prevent secondary infection:

  • First-line options:
    • Moxifloxacin 0.5% drops - superior gram-positive coverage 1
    • Gatifloxacin 0.3% drops - broad-spectrum coverage 1
    • Erythromycin ointment - apply 1 cm ribbon directly to affected eye up to 6 times daily 3
    • Bacitracin ointment - apply directly into conjunctival sac 1-3 times daily 4

• Application frequency:

  • For drops: Every 4-6 hours
  • For ointments: 2-3 times daily (ointments provide longer contact time but may temporarily blur vision) 1

2. Eyelid Protection

• Complete eyelid occlusion using adhesive strips is strongly recommended (Grade 1+) 2
• Apply strips as soon as ciliary reflex is lost to prevent traumatic injuries 2
• Ensure complete apposition of upper and lower eyelids and regularly check effectiveness 2

3. Lubrication

• For high-risk cases, combine eyelid occlusion with:
  • Preservative-free aqueous lubricants (methylcellulose solution)
  • Viscous gel lubricants 2
• Avoid oil-based ointments for high-risk cases 2

Pain Management

• Oral analgesics (acetaminophen or NSAIDs) for pain relief 1
• Consider topical NSAIDs to reduce inflammation and discomfort 1

Important Considerations

Evidence on Patching

• Multiple well-designed studies show that eye patching does not improve healing and may actually hinder it 5, 6, 7
• In one study, patients with traumatic corneal abrasions healed significantly faster and had less pain when not wearing a patch 6

Healing Timeline

• Most corneal abrasions heal within 24-72 hours 5
• Monitor for complete re-epithelialization of the cornea 8

Special Situations

• For contact lens wearers with corneal abrasion:
  • Remove contact lens immediately
  • Use antipseudomonal topical antibiotics
  • Avoid patching or therapeutic contact lens due to increased risk of secondary bacterial keratitis 2

Prevention of Complications

• Prophylactic topical antibiotics should be started within 24 hours of injury to prevent ulceration 2
• For corneal abrasions following trauma, a broad-spectrum topical antibiotic is recommended to prevent both bacterial and fungal infections 2

Follow-up

• Re-examine every 24 hours until corneal healing occurs
• Assess for signs of infection (increased pain, purulent discharge, worsening vision)
• Discontinue treatment once complete healing is achieved

Cautions

• Avoid topical anesthetics for pain management as they may delay healing 1
• Avoid overnight wear of contact lenses as it's a major risk factor for infection 1
• The prevalence of ocular surface disorders in patients with incomplete eyelid closure can be as high as 20-60% 2

By following this treatment protocol, most inner eyelid abrasions will heal completely without complications or long-term sequelae.