Treatment of Corneal Abrasion
The first-line treatment for corneal abrasion is topical broad-spectrum antibiotic drops, particularly fluoroquinolones such as moxifloxacin or gatifloxacin, to prevent secondary bacterial infection. 1, 2
Initial Management
- Apply topical broad-spectrum antibiotic drops 4 times daily as the primary treatment to prevent bacterial keratitis, especially when treatment is started within 24 hours of the abrasion 1, 2
- Fluoroquinolones (moxifloxacin, gatifloxacin) are preferred due to their broad-spectrum coverage and FDA approval for bacterial keratitis treatment 1
- Antibiotic ointment may be used at bedtime for additional protection and lubrication 1, 2
- Avoid eye patching as it does not improve healing and may actually hinder it 1, 2
- Avoid topical steroids initially as they may delay healing and increase infection risk 1, 2
Treatment Algorithm Based on Abrasion Type
For Non-Contact Lens Related Abrasions
- Apply topical antibiotic drops 4 times daily 1
- Consider antibiotic ointment at bedtime for additional protection 1, 2
- Oral analgesics such as acetaminophen or NSAIDs for pain control 1, 3
For 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 4, 1
- Avoid contact lens wear until complete healing is confirmed 1, 5
- Consider antipseudomonal coverage as these patients are at higher risk for Pseudomonas infection 6
Pain Management
- Over-the-counter oral acetaminophen or NSAIDs for residual discomfort 1, 6
- Topical NSAIDs may be considered for pain relief 6
- Cycloplegics are not recommended for uncomplicated corneal abrasions 6
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 in 24 hours 6
- Regular follow-up is necessary to monitor healing and detect early signs of infection 1
Warning Signs Requiring Immediate Care
- Increasing pain, purulent discharge, or corneal infiltrate 2, 5
- High-velocity eye injuries or penetrating trauma 5
- Irregular pupil after trauma 5
- Eye bleeding or loss of vision after trauma 5
Potential Pitfalls and Caveats
- Do not rub the eye as this can worsen the injury 1, 5
- Chronic use of prophylactic antibiotics may promote growth of resistant organisms 1, 5
- Inadequate blinking or incomplete eyelid closure can delay healing 2
- For persistent epithelial defects that don't respond to standard treatment, consider oral doxycycline, autologous serum, or amniotic membrane application 2
Evidence Quality
- Despite the common practice of prescribing antibiotics for corneal abrasions, a Cochrane review found low to very low certainty evidence regarding the efficacy of antibiotic prophylaxis in preventing ocular infection or accelerating epithelial healing 7
- However, the American Academy of Ophthalmology still recommends topical antibiotics as the preferred treatment to prevent secondary bacterial infection 2
- The evidence does not support the use of eye patching, which was traditionally recommended but has been shown not to improve healing 1, 2