Treatment of Corneal Abrasion
Topical broad-spectrum antibiotics are the first-line treatment for corneal abrasions to prevent secondary bacterial infection, especially when treatment is started within 24 hours of the abrasion. 1, 2
First-Line Treatment
- Fluoroquinolones (such as moxifloxacin or gatifloxacin) are preferred due to their broad-spectrum coverage and FDA approval for bacterial keratitis treatment 1
- For non-contact lens wearers with simple abrasions, antibiotic drops alone are typically sufficient 1, 2
- Antibiotic ointment may be used at bedtime for additional protection and lubrication 1, 2
- Apply topical antibiotic drops 4 times daily for simple non-contact lens related abrasions 1
Treatment Based on Abrasion Type
Non-Contact Lens Related Abrasions
- Topical antibiotic drops 4 times daily 1, 2
- Consider antibiotic ointment at bedtime for additional protection 1
- Oral analgesics such as acetaminophen or NSAIDs for pain control 1, 3
Contact Lens Related Abrasions
- More aggressive treatment with frequent antibiotic drops is recommended 1, 4
- Avoid eye patching or therapeutic contact lens use due to increased risk of bacterial keratitis 5, 1
- Avoid contact lens wear until complete healing is confirmed 1, 4
Pain Management
- Over-the-counter oral acetaminophen or NSAIDs can be used for residual discomfort 1, 6
- Topical NSAIDs may be considered for pain relief 6
Important Considerations
- Eye patching is not recommended as it does not improve pain and may delay healing 1, 2, 7
- Topical steroids should be avoided initially as they may delay healing and increase infection risk 1, 2
- Corticosteroids may be considered after 48 hours of antibiotic therapy only when the causative organism is identified and/or the infection has responded to therapy 5
- Corticosteroids should be avoided in cases of suspected Acanthamoeba, Nocardia, or fungus 5
Potential Pitfalls and Caveats
- Do not rub the eye as this can worsen the injury and potentially cause further damage 1, 4
- Chronic use of prophylactic antibiotics may promote growth of resistant organisms 1, 2
- For central or severe keratitis, more aggressive treatment with frequent antibiotic drops is recommended 1
- Patients should be educated about signs and symptoms of infection and instructed to seek prompt ophthalmologic care if worsening occurs 1, 4
- Inadequate blinking or incomplete eyelid closure can delay healing 1, 2
Follow-up Recommendations
- Regular follow-up is necessary to monitor healing and detect early signs of infection 1
- Patients with small (4 mm or less), uncomplicated abrasions, normal vision, and resolving symptoms may not need follow-up 6
- All other patients should be reevaluated in 24 hours 6
- Warning signs requiring immediate follow-up include increasing pain, purulent discharge, or corneal infiltrate 2