What is the treatment for corneal abrasion?

Treatment for Corneal Abrasion

The standard treatment for corneal abrasion includes topical antibiotics, pain management with oral analgesics or topical NSAIDs, and avoidance of eye patching, with follow-up within 24 hours for most cases. 1

Diagnosis

• Confirm diagnosis using fluorescein staining under cobalt-blue filtered light - abrasions appear yellow under normal light and green in cobalt blue light 2
• Carefully examine for and remove any foreign bodies
• Assess size and location of abrasion, and rule out signs of infection or penetrating injury

Treatment Algorithm

Immediate Management

1. Antibiotic Prophylaxis

   • Topical antibiotics are recommended to prevent bacterial superinfection 1, 2
   • For standard corneal abrasions:
     • Bacitracin ophthalmic ointment applied directly to conjunctival sac 1-3 times daily 3
     • Alternative options: moxifloxacin 0.5% or gatifloxacin 0.3% for broader coverage 1
   • For contact lens-related abrasions:
     • Use antipseudomonal coverage (fluoroquinolones preferred) 1
     • Options include ciprofloxacin 0.3%, ofloxacin 0.3%, or levofloxacin 1.5% 1

2. Pain Management

   • Oral analgesics (acetaminophen, NSAIDs) 1, 2
   • Consider topical NSAIDs for pain relief 1, 2
   • Cycloplegic agents may be used for pain from anterior segment inflammation 1

3. Important Do NOTs

   • Do NOT patch the eye - evidence shows it does not improve healing and may delay recovery 1, 4, 2
   • Do NOT use tetracyclines in children under 8 years (risk of teeth staining) 1
   • Do NOT allow contact lens wear until complete healing 1

Follow-up Care

• Re-examine every 24 hours until corneal healing occurs 1
• Most uncomplicated corneal abrasions heal within 24-72 hours 4, 2
• Small abrasions (≤4 mm) with normal vision and resolving symptoms may not require follow-up 2
• All other patients should be reevaluated within 24 hours 1, 2

Special Considerations

When to Refer to Ophthalmology

• Immediate referral (same day) for:
  • Suspected bacterial keratitis or serious ocular infection 1
  • Penetrating eye injury 2
  • Corneal infiltrate or ulcer 2
  • Significant vision loss 2
• Referral within 24 hours for:
  • Minor corneal abrasions without signs of infection 1
  • Symptoms that worsen or do not improve 2

High-Risk Features

• Contact lens wearers (higher risk of Pseudomonas infection) 1, 2
• Large or central abrasions affecting vision
• Signs of infection (increased pain, purulent discharge, worsening vision) 1
• Immunocompromised patients

Prevention

• Recommend protective eyewear for sports and high-risk activities 1
• Educate patients about signs requiring prompt consultation 1
• Avoid overnight wear of contact lenses 1

Evidence Quality

The recommendations are primarily based on guidelines from the American Academy of Ophthalmology 1, with supporting evidence from research studies. While a 2022 Cochrane review 5 found insufficient evidence to determine the superiority of any specific antibiotic regimen over another, topical antibiotics remain standard of care to prevent infection. The evidence against eye patching is strong and consistent across multiple studies 1, 4, 2.