Treatment Plan for Corneal Abrasion with Pain after Foreign Object
For corneal abrasions caused by foreign objects, the recommended treatment includes topical antibiotics, pain management with NSAIDs, and avoiding eye patching. 1, 2
Initial Management
- Do not rub the eye as this can cause further damage by embedding the foreign body deeper or worsening the abrasion 3
- Remove any visible foreign body if possible; if embedded or difficult to remove, refer to an ophthalmologist 3, 4
- Irrigate the eye with sterile saline or commercial eye wash solution to flush out any loose foreign material 3
- Apply a broad-spectrum topical antibiotic as prophylaxis to prevent infection (e.g., moxifloxacin drops four times daily) 1, 2
- Consider using a topical NSAID such as ketorolac tromethamine ophthalmic solution for pain relief, which has been shown to significantly decrease pain, photophobia, and foreign body sensation 5, 6
Pain Management
- Topical NSAIDs (like ketorolac) are effective for pain control and have been shown to reduce symptoms without delaying healing 5, 2
- Oral analgesics such as acetaminophen or NSAIDs can be used for additional pain relief 3, 2
- Cycloplegic agents (e.g., cyclopentolate) may be used to decrease pain from ciliary spasm and anterior segment inflammation 1, 2
Important Treatment Considerations
- Do NOT patch the eye - multiple well-designed studies show that patching does not help and may hinder healing 7, 2
- For contact lens-related abrasions, use antipseudomonal topical antibiotics and discontinue contact lens wear until complete healing 2, 3
- Patients with diabetes mellitus, ocular surface diseases, or corneal epithelial defects should use topical NSAIDs with caution due to increased risk of corneal adverse events 6
- Topical NSAIDs should not be used more than 24 hours prior to surgery or beyond 14 days post-injury as this may increase risk of corneal adverse events 6
Follow-up Recommendations
- Small uncomplicated abrasions (≤4 mm) with normal vision and resolving symptoms may not require follow-up 2
- All other patients should be reevaluated within 24 hours 2, 4
- Most corneal abrasions heal within 24-72 hours 7, 2
Indications for Immediate Referral
- Symptoms that worsen or do not improve with treatment 2
- Development of a corneal infiltrate or ulcer 2
- Significant vision loss 2
- Penetrating eye injury or suspicion of intraocular foreign body 3, 2
- High-velocity eye injuries (e.g., from grinding or nailing) 3
Cautions and Contraindications
- Ketorolac and other topical NSAIDs may slow or delay healing in some patients 6
- Concomitant use of topical NSAIDs and topical steroids may increase potential for healing problems 6
- Patients with bleeding tendencies or who are on medications that prolong bleeding time should use ketorolac with caution 6
- Do not administer ketorolac while wearing contact lenses 6