Bandage Contact Lens for Mild Corneal Abrasions
Direct Answer
For mild corneal abrasions, ophthalmologists typically use thin, high water content soft contact lenses with high oxygen permeability (high Dk levels) as bandage contact lenses, though these are generally not needed for simple abrasions and are reserved for cases with delayed healing or significant discomfort. 1
When Bandage Contact Lenses Are Indicated
Bandage contact lenses (BCLs) are helpful in cases of delayed healing but are generally not needed for simple, uncomplicated corneal abrasions. 1 The primary indications include:
- Relief of discomfort or pain from microcystic or bullous epithelial disease 2
- Persistent epithelial defects that don't respond to standard antibiotic treatment 1
- Corneal protection when standard healing is inadequate 3
Specific Lens Characteristics
The ideal bandage contact lens should have the following properties:
- Thin lenses with high water content 2
- High oxygen diffusion coefficients (high Dk levels) to minimize hypoxia risk 2
- Flat fitting with some movement on blinking to allow tear exchange 2
- Large diameter lenses can be fitted satisfactorily without keratometry 4
Popular lens choices include ACUVUE and Focus Night & Day lenses, which are the most commonly prescribed by North American practitioners. 5
Critical Management Requirements
When using a BCL, you must prescribe a topical prophylactic broad-spectrum antibiotic to decrease the risk of secondary infection. 2 This is non-negotiable given the increased infection risk.
Patients must be explicitly warned about:
- The risk of infectious keratitis while wearing a BCL 2
- The need to immediately contact their ophthalmologist if redness, pain, or increased photophobia develops 2
- That antibiotics may not fully prevent the risk of infection 2
Duration and Follow-up
BCLs should ideally be used for a limited treatment period, not as a long-term solution. 2 When longer-term use is required:
- Periodic exchange of the lens is mandatory 2
- The same lens should not remain on the eye for longer than one month 2
- Regular follow-up is necessary to reassess the lens and monitor for complications 2
Extended wear for 30 days with monthly replacement has been shown effective in specific conditions like epidermolysis bullosa 6, but this represents specialized use beyond simple abrasions.
Special Considerations for Contact Lens Wearers
Avoid bandage contact lenses for traumatic abrasions in contact lens wearers due to higher risk of Pseudomonas infection. 7 These patients require:
- Immediate discontinuation of their regular contact lens use 7
- More aggressive antibiotic coverage with fluoroquinolones 7
Adjunctive Measures
If concomitant dry eye disease is present, preservative-free artificial tears may be necessary to facilitate sufficient lens movement 2. This prevents the lens from adhering too tightly to the corneal surface.
Common Pitfalls to Avoid
Do not use eye patching - this outdated practice does not improve comfort or speed of healing and may actually hinder healing 1. This represents a major shift from historical practice.
Do not consider BCLs as first-line treatment for simple abrasions - topical broad-spectrum antibiotic drops (preferably fluoroquinolones like moxifloxacin or gatifloxacin) remain the preferred initial treatment 1. BCLs are reserved for cases that don't respond adequately to standard therapy.
Avoid topical steroids initially as they may delay healing and increase infection risk 1.