What is the treatment for corneal abrasion?

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 Algorithm

• Apply topical antibiotic drops, with fluoroquinolones (such as moxifloxacin) preferred, 3 times daily for 7 days 1, 3
• For additional protection, antibiotic ointment may be used at bedtime 1, 2
• Pain control with oral analgesics such as acetaminophen or NSAIDs is recommended 2, 4
• Avoid eye patching as it does not improve comfort or speed of healing and may actually hinder healing 1, 5
• Bandage contact lenses may be helpful in cases of delayed healing but are generally not needed for simple abrasions 1, 5

Antibiotic Selection

• The choice of antibiotic should take into account:
  • Normal flora of the skin and conjunctiva 5
  • Patient's immune status 5
  • Underlying medical conditions (e.g., diabetes) 5
• Fluoroquinolones such as moxifloxacin or gatifloxacin are preferred due to their broad-spectrum coverage and FDA approval for bacterial keratitis treatment 1, 3
• For contact lens wearers, antipseudomonal coverage is essential 4

Important Considerations

• Adequate blinking during waking hours and complete eyelid closure when sleeping are critical for ocular surface healing 5
• A temporary tarsorrhaphy with botulinum toxin or suture can be helpful when blinking or eyelid closure is inadequate 5
• Amniotic membranes may be considered for persistent defects but are not indicated for routine corneal abrasions 1, 5

Follow-Up Recommendations

• Small (≤4 mm), uncomplicated abrasions with normal vision and resolving symptoms may not require follow-up 4
• All other patients should be reevaluated within 24 hours 4
• Warning signs requiring immediate care include:
  • Increasing pain 1, 6
  • Purulent discharge 1, 6
  • Corneal infiltrate 1, 6
  • Significant vision loss 4

Potential Pitfalls to Avoid

• Rubbing the eye can worsen the injury and potentially cause further damage 2, 6
• Chronic use of prophylactic antibiotics may promote resistant organisms 1, 2
• Topical steroids should be avoided initially as they may delay healing and increase infection risk 1, 2
• Pressure patching was traditionally used but is no longer recommended as it does not positively impact comfort or healing speed 5

Special Considerations

• For contact lens-related abrasions:
  • Avoid contact lens wear until complete healing is confirmed 2, 6
  • Do not use eye patches due to increased risk of bacterial keratitis 2, 6
  • Use antipseudomonal topical antibiotics 4
• For persistent epithelial defects that don't respond to standard treatment:
  • Consider oral doxycycline, autologous serum, or amniotic membrane application 5
  • Nerve growth factor has shown effectiveness for neurotrophic keratopathy 5