Treatment of Corneal Abrasions
The first-line treatment for corneal abrasions is topical broad-spectrum antibiotic drops, with fluoroquinolones such as moxifloxacin or gatifloxacin being the preferred options to prevent secondary bacterial infection. 1, 2
First-Line Treatment Algorithm
- Apply topical antibiotic drops, preferably fluoroquinolones, 3-4 times daily for 7 days 1, 3
- Antibiotic ointment may be used at bedtime for additional protection and lubrication 1, 2
- Do NOT patch the eye as it does not improve healing and may actually hinder it 1, 4
- For pain control, use oral analgesics such as acetaminophen or NSAIDs 2, 5
Antibiotic Selection
- Fluoroquinolones (moxifloxacin, gatifloxacin) are preferred due to their broad spectrum coverage and FDA approval for bacterial keratitis treatment 1, 2
- For non-contact lens wearers with simple abrasions, antibiotic drops alone are typically sufficient 1
- For contact lens-related abrasions, use antipseudomonal topical antibiotics 5
- Moxifloxacin dosing: instill one drop in the affected eye 3 times a day for 7 days 3
Special Considerations
- Contact lens wearers should avoid wearing contacts until complete healing is confirmed 2, 5
- For persistent epithelial defects that don't respond to standard treatment, consider oral doxycycline, autologous serum, or amniotic membrane application 1
- Bandage contact lenses may be helpful in cases of delayed healing but are generally not needed for simple abrasions 1
- Adequate blinking during waking hours and complete eyelid closure when sleeping are critical for ocular surface healing 1
Warning Signs Requiring Immediate Follow-up
- Increasing pain, purulent discharge, or corneal infiltrate 1, 2
- Irregular pupil after trauma or eye bleeding 6
- Loss of vision after trauma 6
- Signs of infection (increasing pain, purulent discharge, corneal infiltrate) 2, 6
Potential Pitfalls to Avoid
- Avoid topical steroids initially, as they may delay healing and increase infection risk 1, 2
- Avoid rubbing the eye as this can worsen the injury and potentially cause further damage 1, 2
- Chronic use of prophylactic antibiotics may promote resistant organisms 1, 2
- Patching is not recommended for contact lens wearers due to increased risk of bacterial keratitis 2, 6
Evidence Quality Assessment
The recommendations are primarily based on guidelines from the American Academy of Ophthalmology, which represent the highest level of evidence available. While a 2022 Cochrane review 7 noted that the beneficial effects of antibiotic prophylaxis remain unclear due to limited high-quality studies, clinical practice guidelines still recommend topical antibiotics as standard care to prevent potential infection, which could lead to significant morbidity if untreated.