Best Eye Drops for Corneal Abrasion
For corneal abrasions, preservative-free lubricant eye drops (such as nonpreserved hyaluronate or carmellose) applied every two hours are the first-line treatment, with broad-spectrum topical antibiotics like moxifloxacin 0.5% recommended when there is corneal fluorescein staining or ulceration. 1
First-Line Treatment Options
Lubricant Eye Drops
- Preservative-free lubricants should be applied every two hours during the acute phase 2
- Recommended options include:
- Nonpreserved hyaluronate
- Carmellose
- These lubricants help maintain corneal moisture and promote healing
Antibiotic Prophylaxis
- Broad-spectrum topical antibiotics are recommended when there is:
- Corneal fluorescein staining
- Frank ulceration
- Preferred options according to the American Academy of Ophthalmology 1:
- Moxifloxacin 0.5% (four times daily)
- Gatifloxacin 0.3% (four times daily)
- Other quinolone preparations (levofloxacin, ciprofloxacin, ofloxacin)
Pain Management
- Topical NSAIDs can significantly reduce pain, photophobia, and foreign body sensation 3
- Ketorolac tromethamine 0.5% has been shown to decrease pain levels and allow faster resumption of normal activities
- Cycloplegic agents (e.g., cyclopentolate) can decrease pain from anterior segment inflammation 1
Important Considerations
Duration of Treatment
- Continue treatment until complete healing is achieved 1
- Most corneal abrasions heal within 24-72 hours 4
- Regular reassessment every 24 hours until corneal healing occurs 1
Preservative Concerns
- Preservative-containing formulations should only be used ≤4 times/day 1
- For more frequent administration (>4 times/day), preservative-free formulations are essential to avoid ocular surface toxicity 1
What to Avoid
- Eye patching is not recommended as multiple well-designed studies show it does not help and may hinder healing 4
- Blind sweeping of the fornices with a cotton bud or glass rod should be avoided as it may potentially cause damage 2
Follow-Up and Referral
- For minor corneal abrasions without signs of infection, referral to an ophthalmologist within 24 hours is recommended 1
- For suspected bacterial keratitis or serious ocular infection, immediate referral to an ophthalmologist is necessary 1
Monitoring for Complications
- Monitor for signs of improvement:
- Reduced pain
- Decreased discharge
- Lessened eyelid edema
- Reduced conjunctival injection 1
- If no improvement is seen within 48 hours, consider modifying therapy 1
- Watch for signs of infection (increased pain, purulent discharge, worsening vision) 1
The evidence for antibiotic prophylaxis in preventing ocular infection or accelerating epithelial healing following corneal abrasion remains of low to very low certainty 5. However, clinical guidelines still recommend their use in cases with fluorescein staining or ulceration to prevent potential infection.