What are the recommended ophthalmic drops for treating corneal abrasion?

Recommended Ophthalmic Drops for Corneal Abrasion

For corneal abrasions, broad-spectrum topical antibiotics such as moxifloxacin 0.5% administered four times daily are recommended until complete healing occurs, along with preservative-free lubricants every two hours to maintain corneal moisture and promote healing. 1

First-Line Treatment Algorithm

1. Antibiotic Prophylaxis:

   • First choice: Moxifloxacin 0.5% or gatifloxacin 0.3% four times daily 1
   • Alternatives: Ciprofloxacin 0.3%, ofloxacin 0.3%, or levofloxacin 1.5% four times daily 1
   • For contact lens wearers: Use antipseudomonal coverage (fluoroquinolones provide this coverage) 1

2. Lubricating Drops:

   • Preservative-free lubricants every two hours to maintain corneal moisture and promote healing 1

3. Pain Management:

   • Topical NSAIDs for pain relief 1, 2
   • Oral analgesics (acetaminophen, NSAIDs) as needed 1
   • Cycloplegic agents for significant pain from anterior segment inflammation 1

Treatment Duration and Follow-up

• Continue treatment until complete healing is achieved 1
• Small abrasions typically heal within 24-72 hours 1
• For small (<4mm), uncomplicated abrasions with normal vision and resolving symptoms, follow-up may not be necessary 3
• For larger abrasions (>4mm) or worsening symptoms, reassessment every 24 hours until corneal healing occurs 1

Special Considerations

Contact Lens Wearers

• Avoid pressure patching and bandage contact lenses due to higher risk of secondary infection 1
• Discontinue contact lens wear during treatment 1
• Use antipseudomonal antibiotics (fluoroquinolones are appropriate) 1, 3

Severe Cases

• For large/visually significant infiltrates, consider fortified antibiotics (cefazolin 5% + tobramycin 1.3%) 1
• For ofloxacin specifically, the FDA-approved regimen for corneal ulcers is more intensive:
  • Days 1-2: One to two drops every 30 minutes while awake, plus at 4 and 6 hours after retiring
  • Days 3-7/9: One to two drops hourly while awake
  • Days 7/9 through treatment completion: One to two drops four times daily 4

Evidence Quality and Considerations

The American Academy of Ophthalmology guidelines provide the strongest evidence for management of corneal abrasions 1. While traditional practices like eye patching were once common, multiple well-designed studies have shown that patching does not help and may hinder healing 5, 3.

Topical NSAIDs have been shown to provide increased patient comfort without adverse effects. In a randomized controlled trial, ketorolac tromethamine 0.5% ophthalmic solution significantly decreased levels of pain, photophobia, and foreign body sensation compared to placebo 2.

Regarding antibiotic prophylaxis, while commonly prescribed to prevent bacterial superinfection, a Cochrane review found insufficient evidence to determine whether antibiotics prevent infection or accelerate epithelial healing following corneal abrasion 6. However, guidelines still recommend their use, particularly for contact lens wearers or cases with fluorescein staining or ulceration 1.

Common Pitfalls to Avoid

1. Avoid pressure patching - Evidence shows it does not improve pain and may delay healing 5, 3
2. Don't miss signs of serious complications - Watch for worsening pain, decreased vision, increased redness/swelling, yellow/green discharge, or lack of improvement within 48 hours 1
3. Don't forget to assess for foreign bodies - Careful examination and removal of any foreign bodies is essential 3
4. Don't continue contact lens wear during treatment 1
5. Don't miss signs requiring referral - Any patient with symptoms that worsen, corneal infiltrate or ulcer, significant vision loss, or penetrating eye injury should be referred to an ophthalmologist 3