Treatment of Corneal Abrasions
Topical broad-spectrum antibiotics are the first-line treatment for corneal abrasions to prevent secondary bacterial infection. 1, 2
First-Line Treatment Options
- Fluoroquinolones (such as moxifloxacin or gatifloxacin) are preferred due to their broad-spectrum coverage and FDA approval for bacterial keratitis treatment 2
- For non-contact lens wearers with simple abrasions, antibiotic drops alone are typically sufficient 2
- Antibiotic ointment may be used at bedtime for additional protection and lubrication 2
- Bacitracin ophthalmic ointment is FDA-approved for superficial ocular infections involving the cornea caused by susceptible organisms 3
- Chloramphenicol ointment has been shown to be effective in preventing corneal ulcers when applied within 48 hours of corneal abrasion 4
Treatment Algorithm Based on Abrasion Type
For Simple, Non-Contact Lens Related Abrasions:
- Apply topical antibiotic drops (fluoroquinolones preferred) 4 times daily 2
- Consider antibiotic ointment at bedtime for additional protection 2
- Pain control with oral analgesics (acetaminophen or NSAIDs) 1, 5
- Topical NSAIDs significantly reduce pain in the first 48 hours and decrease the need for oral analgesics 5
For Contact Lens Related Abrasions:
- Use antipseudomonal topical antibiotics (fluoroquinolones) due to higher risk of Pseudomonas infection 6
- Avoid contact lens wear until complete healing is confirmed 1
- Do not use eye patches in contact lens wearers due to increased risk of bacterial keratitis 1
Important Considerations
- Patching is not recommended as it does not improve pain and may delay healing 2, 5
- Topical steroids should be avoided initially as they may delay healing and increase infection risk 2
- Bandage contact lenses may be helpful in cases of delayed healing but are generally not needed for simple abrasions 2, 7, 8
- Prophylactic antibiotics are most effective when started within 24 hours of the abrasion 1
Follow-Up Recommendations
- Small (≤4 mm), uncomplicated abrasions with normal vision and resolving symptoms may not require follow-up 6
- All other patients should be reevaluated within 24 hours 6
- Immediate referral is indicated for patients with worsening symptoms, corneal infiltrate or ulcer, significant vision loss, or penetrating eye injury 6
Potential Pitfalls and Caveats
- Chronic use of prophylactic antibiotics may promote resistant organisms 2
- Rubbing the eye can worsen the injury and potentially cause further damage 1
- Warning signs requiring immediate care include increasing pain, purulent discharge, corneal infiltrate, or vision loss 2, 6
- Inadequate blinking or incomplete eyelid closure can delay healing 2
- The evidence supporting antibiotic prophylaxis in preventing ocular infection is of low to very low certainty, but remains standard practice due to the serious consequences of infection 9