Can Muro 128 (sodium chloride hypertonic ophthalmic ointment) be used to treat corneal abrasions?

Muro 128 Should Not Be Used for Treating Corneal Abrasions

Muro 128 (sodium chloride hypertonic ophthalmic ointment) is not indicated for treating corneal abrasions and should not be used for this purpose. According to the FDA label, Muro 128 is specifically indicated for "temporary relief of corneal edema" only 1.

Appropriate Treatment for Corneal Abrasions

First-Line Treatment

• Topical broad-spectrum antibiotics are the recommended prophylactic treatment for corneal abrasions 2, 3
• Preferred options include:
  • Fluoroquinolones (ciprofloxacin 0.3%, ofloxacin 0.3%, levofloxacin 1.5%) for small, non-central ulcers 2, 3
  • Moxifloxacin 0.5% or gatifloxacin 0.3% for broad-spectrum coverage 3
  • Fortified antibiotics (cefazolin 5%, tobramycin 1.3%) for large/visually significant infiltrates 2, 3

Additional Treatment Components

1. Cycloplegic agents to decrease pain from anterior segment inflammation and prevent synechiae formation 2
2. Pain management:
   • Oral analgesics (acetaminophen, NSAIDs) 3
   • Topical NSAIDs can provide increased patient comfort without adverse effects 4
3. Avoid patching for contact lens-related abrasions due to increased risk of secondary bacterial keratitis 2, 3

Treatment Algorithm for Corneal Abrasions

1. Assess the abrasion:

   • Size, depth, location (central vs. peripheral)
   • Presence of infiltrate or hypopyon
   • Contact lens association

2. For small, non-central abrasions:

   • Topical fluoroquinolone (ciprofloxacin 0.3%, ofloxacin 0.3%, or levofloxacin 1.5%)
   • Cycloplegic agent for pain relief
   • Consider topical NSAID for additional pain control

3. For large or visually significant abrasions:

   • Consider fortified antibiotics, especially if hypopyon is present
   • More frequent dosing (loading dose every 5-15 minutes followed by hourly application)
   • Closer follow-up

4. For contact lens-related abrasions:

   • Antipseudomonal coverage
   • Avoid patching or bandage contact lens
   • Discontinue contact lens wear until complete healing

Important Caveats and Pitfalls

• Do not use Muro 128 for corneal abrasions as it is only indicated for corneal edema 1
• Avoid pressure patching in contact lens wearers due to increased risk of infection 2, 3
• Ointments have limited penetration into the cornea for therapeutic benefit, though they may be useful at bedtime in less severe cases 2
• Monitor for signs of infection: increased pain, purulent discharge, worsening vision 3
• Re-examine every 24 hours until corneal healing occurs (typically within 24-72 hours) 3
• Prophylactic antibiotics should be started within 24 hours of abrasion to prevent ulceration 2

While various treatment approaches exist (patching vs. no patching, ointment vs. drops, contact lens vs. no contact lens), the evidence suggests that topical antibiotics are the cornerstone of treatment 5, 6. The specific choice can be adapted to patient needs and preferences, but hypertonic sodium chloride solutions like Muro 128 have no established role in corneal abrasion management.