Treatment of Corneal Abrasions
Yes, topical antibiotics should be prescribed for corneal abrasions to prevent bacterial keratitis, with treatment initiated within 24 hours of injury. 1, 2
Antibiotic Prophylaxis
When to Use Antibiotics
- A broad-spectrum topical antibiotic should be prescribed for any patient presenting with corneal abrasion following trauma, as prophylactic antibiotics prevent ulceration when started within 24 hours of the abrasion. 1, 2
- Contact lens wearers require mandatory antibiotic coverage due to increased risk of Pseudomonas aeruginosa infection. 2, 3
Preferred Antibiotic Formulations
- Topical antibiotic eye drops are the preferred method of treatment over ointments because they achieve higher tissue levels in the cornea. 1
- Fluoroquinolones (ofloxacin, moxifloxacin, gatifloxacin) are recommended as first-line agents due to broad-spectrum coverage, including Pseudomonas in contact lens wearers. 2, 3
- Tetracycline ointment lacks adequate corneal penetration and should only be used at bedtime as adjunctive therapy to antibiotic drops in less severe cases, not as monotherapy. 1
Dosing Strategy
- For minor abrasions: Apply fluoroquinolone drops 4 times daily. 3
- For central or severe keratitis: Use aggressive dosing with loading doses every 5-15 minutes followed by hourly applications. 2, 3
Pain Management
- Topical NSAIDs (such as diclofenac) provide effective pain relief without delaying healing. 4
- Oral acetaminophen or NSAIDs are reasonable alternatives for residual discomfort. 1
- Topical cycloplegic agents may be considered only if substantial anterior chamber inflammation is present, though evidence does not support routine use for uncomplicated abrasions. 1, 5
What NOT to Do
- Do not patch the eye, as multiple studies show patching does not help healing and may hinder it. 6, 5
- Never patch contact lens-related abrasions due to significantly increased risk of secondary bacterial keratitis. 1, 2
- Do not use therapeutic contact lenses in contact lens wearers for the same infection risk concerns. 1
Special Considerations and Pitfalls
Contact Lens Wearers
- Require antipseudomonal coverage with fluoroquinolones. 2, 3, 5
- Must discontinue contact lens wear until complete healing is confirmed. 1
Fluoroquinolone Resistance
- Risk factors include recent fluoroquinolone use, hospitalization, advanced age, and recent ocular surgery. 2, 3
- MRSA isolates generally have poor susceptibility to fluoroquinolones. 3
- Chronic prophylactic antibiotic use may promote resistant organisms. 1
Severe Cases Requiring Escalation
- Deep stromal involvement or infiltrates larger than 2 mm with extensive suppuration may require fortified antibiotics instead of or in addition to fluoroquinolones. 3
Protective Measures
- Tape a hard plastic eye shield, paper cup, or plastic cup over the eye to prevent unintentional rubbing. 1
- Do not rub the eye, as this worsens injury and causes further corneal epithelial damage. 1
Warning Signs Requiring Immediate Ophthalmology Referral
- High-velocity injuries or penetrating trauma. 1
- Irregular pupil after trauma. 1
- Eye bleeding or vision loss. 1
- Increasing pain, purulent discharge, or corneal infiltrate suggesting infection. 1
- Persistent foreign-body sensation indicating incomplete healing or complications. 1
Follow-Up
- Small abrasions (≤4 mm) with normal vision and resolving symptoms may not require follow-up. 5
- All other patients should be reevaluated in 24 hours to monitor healing and detect early infection signs. 1, 5
- Educate patients about infection symptoms and instruct them to seek prompt care if worsening occurs. 1