What antibiotic eyedrop (antibiotic ophthalmic solution) is recommended for a 60-year-old male with a corneal abrasion who does not use contact lenses (CL)?

Antibiotic Eyedrop Selection for Corneal Abrasion in a 60-Year-Old Non-Contact Lens Wearer

For a 60-year-old male with corneal abrasion who does not use contact lenses, moxifloxacin 0.5% ophthalmic solution is the recommended first-line antibiotic eyedrop, administered four times daily until complete healing occurs. 1

Rationale for Antibiotic Selection

Broad-spectrum antibiotic coverage is essential for corneal abrasions to prevent secondary infection. The American Academy of Ophthalmology specifically recommends:

• Moxifloxacin 0.5%: Preferred first-line option for non-contact lens wearers due to:

  • Excellent broad-spectrum coverage, particularly against gram-positive organisms
  • Convenient dosing schedule (four times daily)
  • High corneal penetration
  • Lower risk of resistance compared to older fluoroquinolones 1

• Alternative options (if moxifloxacin is unavailable):

  • Gatifloxacin 0.3% (similar broad-spectrum coverage) 1, 2
  • Ofloxacin 0.3% (for small, non-central abrasions) 1, 3
  • Ciprofloxacin 0.3% (for small, non-central abrasions) 1

Treatment Protocol

1. Dosing schedule: Apply moxifloxacin 0.5% eyedrops four times daily 1

2. Duration: Continue until complete epithelial healing occurs (typically 24-72 hours for small abrasions) 1

3. Adjunctive therapy:

   • Preservative-free lubricants every two hours to maintain corneal moisture and promote healing
   • Consider oral analgesics (acetaminophen, NSAIDs) for pain management
   • Topical NSAIDs may also provide pain relief 1

Monitoring and Follow-up

• For small abrasions (<4mm): Follow-up within 48 hours

• For large abrasions (>4mm): Follow-up within 24 hours 1

• Monitor for signs of complications:

  • Worsening pain
  • Decreased or blurred vision
  • Increased redness or swelling
  • Yellow or green discharge
  • Lack of improvement within 48 hours 1

Important Considerations

• Non-contact lens wearers typically have different bacterial flora than contact lens wearers, with gram-positive organisms predominating 1

• Avoid corneal toxicity: Recent research has shown that prolonged use of moxifloxacin at high frequency can lead to corneal deposits, so adherence to recommended dosing is important 4

• Evidence limitations: A 2022 Cochrane review noted limited high-quality evidence for specific antibiotic regimens in corneal abrasion, but clinical practice guidelines still recommend prophylactic antibiotics to prevent secondary infection 5

• Fortified antibiotics (such as cefazolin 5% or tobramycin 1.3%) are generally reserved for more severe cases with large/visually significant infiltrates, not typically needed for simple corneal abrasions 1

By following these evidence-based recommendations, you can provide optimal care for this 60-year-old male with corneal abrasion while minimizing the risk of complications and promoting rapid healing.