What is the immediate treatment for a corneal abrasion?

Immediate Treatment for Corneal Abrasion

The immediate treatment for corneal abrasion should include preservative-free lubricants applied every two hours, topical antibiotics for infection prevention, oral or topical NSAIDs for pain relief, and cycloplegic agents to reduce pain from anterior segment inflammation. 1

Initial Assessment and Management

1. Confirm diagnosis:

   • Visualize the cornea under cobalt-blue filtered light after fluorescein application 2
   • Abrasion will appear yellow under normal light and green in cobalt blue light 3
   • Carefully examine for and remove any foreign bodies 3

2. Pain management:

   • Topical NSAIDs (e.g., diclofenac) for significant pain relief 1, 4
   • Oral analgesics (acetaminophen, NSAIDs) as needed 1
   • Cycloplegic agents to decrease pain from anterior segment inflammation 1

3. Infection prevention:

   • Apply topical broad-spectrum antibiotics 1, 5
   • For contact lens-related abrasions, use antipseudomonal topical antibiotics 3

4. Corneal healing promotion:

   • Preservative-free lubricants every two hours 1
   • Daily ocular hygiene to remove inflammatory debris 1
   • Avoid blind sweeping of the fornices with cotton buds 1

Important Treatment Considerations

• Do NOT patch the eye: Multiple well-designed studies show that patching does not help and may hinder healing 2, 3
• Bandage contact lenses: May be considered as an alternative to patching for significant pain relief while allowing binocular vision 4
• Antibiotic selection: For uncomplicated abrasions, standard topical antibiotics are sufficient; for contact lens wearers, use antipseudomonal coverage 1, 3

Follow-up Recommendations

• Small uncomplicated abrasions (≤4mm) with normal vision and resolving symptoms may not require follow-up 3
• Large abrasions (>4mm) or worsening symptoms warrant follow-up evaluation within 24 hours 1
• Complete healing typically occurs within 24-72 hours 1, 2

When to Refer to Ophthalmology

• Immediate referral (same day) for:

  • Suspected bacterial keratitis or serious ocular infection 1
  • Penetrating eye injury 5
  • Corneal ulcer 5
  • Significant vision loss 3

• Referral within 24 hours for:

  • Minor corneal abrasions without signs of infection 1
  • Symptoms that worsen or fail to improve 3
  • Development of corneal infiltrate 3

Common Pitfalls to Avoid

• Delaying treatment, which can lead to infection or corneal erosion 5
• Using eye patches, which can delay healing 2, 3
• Failing to recognize signs of serious complications requiring immediate referral 5
• Not providing adequate pain control, which can significantly impact patient comfort and function 4

Prevention Education

• Recommend protective eyewear for sports and high-risk activities 1, 2
• Educate patients about signs requiring prompt consultation: worsening pain, decreased vision, increased redness/swelling, discharge, or lack of improvement within 48 hours 1