What is the treatment for a corneal abrasion?

Treatment of Corneal Abrasions

The most effective treatment for corneal abrasions includes topical antibiotics to prevent infection, pain management with NSAIDs or oral analgesics, and avoidance of eye patching. 1, 2

Initial Management

• Patients with corneal abrasions should not rub their eyes as this can worsen the injury 3
• For protection against unintentional touching, tape a hard plastic eye shield, paper cup, or plastic cup over the affected eye 3
• For low-energy foreign bodies (dust, dirt, eyelash), allow natural tears to wash out the object or irrigate with tap water or commercial eye wash solution 3

Antibiotic Treatment

• Broad-spectrum topical antibiotics should be prescribed to prevent bacterial superinfection, especially when treatment begins within 24 hours of the abrasion 1, 4
• For contact lens-related abrasions, antipseudomonal topical antibiotics are specifically recommended 2
• The American Academy of Ophthalmology recommends topical antibiotic eye drops as the preferred method due to their ability to achieve high tissue levels in the cornea 1
• In resource-limited settings, chloramphenicol ointment 1% three times daily for 3 days has been shown to be effective in preventing corneal ulcers 3

Pain Management

• Over-the-counter oral acetaminophen or NSAIDs can be used to treat residual discomfort after foreign body removal 3
• Topical NSAIDs may also provide effective pain relief 2, 5
• Evidence does not support the use of topical cycloplegics for uncomplicated corneal abrasions 2

Important Treatment Considerations

• Eye patching is NOT recommended as it does not improve pain and may delay healing 2, 5
• Patients who develop foreign body sensation associated with contact lens use should remove the lens, discontinue use, and seek medical attention 3
• For severe cases or central keratitis, more aggressive treatment with frequent antibiotic drops (particularly fluoroquinolones) is recommended 1

Follow-up Recommendations

• Small (≤4 mm), uncomplicated abrasions with normal vision and resolving symptoms may not require follow-up 2
• All other patients should be reevaluated within 24 hours 2
• Seek immediate medical attention for:
  • High-velocity eye injuries (grinding, nailing, machinery) 3
  • Penetrating eye injuries from sharp or metal objects 3
  • Irregular pupil, eye bleeding, or vision loss after trauma 3
  • Persistent foreign body sensation 3
  • Symptoms that worsen or fail to improve 2
  • Development of corneal infiltrate or ulcer 2

Prevention of Complications

• Chronic use of prophylactic antibiotics should be avoided to prevent development of resistant organisms 1
• For patients who wear contact lenses, the risks and timing of resuming contact lens wear should be discussed, and lens choice and fitting should be reassessed 3
• Visual rehabilitation should be considered for patients with substantial visual impairment resulting from corneal abrasions 3

Special Populations

• In critically ill patients receiving neuromuscular blockade, prophylactic eye care should begin immediately to prevent corneal abrasions 3
• Artificial-tear ointment is more effective than passive eyelid closure in preventing exposure keratitis in mechanically ventilated patients 3