From the Guidelines
Broad-spectrum topical antibiotics are used to treat corneal abrasions, particularly in patients who wear contact lenses or have suffered trauma, to prevent acute bacterial keratitis.
Key Points
- Topical antibiotics should be prescribed to prevent acute bacterial keratitis in patients with a corneal abrasion who wear contact lenses or suffered trauma 1.
- A broad-spectrum topical antibiotic is recommended for any patient presenting with corneal abrasion following trauma 1.
- Fluoroquinolones, such as ciprofloxacin 0.3%, ofloxacin 0.3%, and levofloxacin 1.5%, have been approved by the FDA for the treatment of bacterial keratitis and are effective in treating corneal abrasions 1.
- Chloramphenicol ointment 1% has also been shown to be effective in preventing corneal ulcers in patients with corneal abrasions 1.
Considerations
- The use of fortified topical antibiotics may be considered for large and/or visually significant corneal infiltrates, especially if a hypopyon is present 1.
- Corticosteroids may be considered after 24 to 48 hours of antibiotic therapy when the causative organism is identified and/or the infection has responded to therapy, but should be avoided in cases of suspected Acanthamoeba, Nocardia, or fungus 1.
- The increasing resistance of methicillin-resistant Staphylococcus aureus (MRSA) and Pseudomonas aeruginosa to topical fluoroquinolones should be taken into consideration when selecting an antibiotic 1.
From the Research
Antibiotics Used to Treat Corneal Abrasions
- Chloramphenicol ocular ointment 2
- Fusidic acid ocular gels 2
- Chloramphenicol-clotrimazole ocular ointment combination 2
- Tobramycin antibiotic drops 3
- Antipseudomonal topical antibiotics for contact lens-related abrasions 4
Treatment Regimens
- Topical antibiotic alone 5
- Antibiotic together with a cycloplegic 5
- Combination of soft contact lenses, NSAID drops, and antibiotic drops without cycloplegia 3
Key Findings
- The current evidence is insufficient to support any antibiotic regimen being superior to another 2
- Topical antibiotics are commonly prescribed to prevent bacterial superinfection, although evidence is lacking 4
- The use of topical nonsteroidal anti-inflammatory drugs (NSAIDs) and antibiotics can provide pain relief and promote healing 3