Treatment of Corneal Abrasion
Immediate Antibiotic Prophylaxis
All corneal abrasions require topical broad-spectrum antibiotic prophylaxis to prevent bacterial keratitis, with treatment ideally initiated within 24 hours of injury. 1
Standard Treatment Protocol
Topical antibiotic drops are the preferred treatment method due to their superior corneal penetration and ability to achieve high tissue levels 1, 2
Fluoroquinolones (moxifloxacin or gatifloxacin) are the first-line agents for most corneal abrasions given their broad-spectrum coverage and FDA approval for bacterial keratitis treatment 2, 3, 4
Apply antibiotic drops 4 times daily until complete healing is confirmed 3
Antibiotic ointment (such as erythromycin or bacitracin) may be added at bedtime for additional protection and lubrication in less severe cases 1, 2, 5
High-Risk Situations Requiring Enhanced Coverage
Contact lens-related abrasions demand antipseudomonal coverage (fluoroquinolones mandatory) due to significantly elevated infection risk 1, 2
Trauma-related abrasions require broad-spectrum antibiotics to prevent both bacterial and fungal infection 1
Pain Management
Oral acetaminophen or NSAIDs are appropriate for pain control 2, 3
Topical cycloplegics are not recommended for uncomplicated abrasions as evidence does not support their routine use 6
Critical Management Principles
What NOT to Do
Never patch the eye - patching does not improve pain or healing and may actually delay epithelialization 3, 4, 6, 7
Avoid patching or bandage contact lenses in contact lens wearers due to increased risk of secondary bacterial keratitis 1, 2
Do not use topical corticosteroids initially as they delay healing and increase infection risk 3, 4
Instruct patients not to rub the eye as this worsens injury and causes further epithelial damage 2, 3, 4
Protective Measures
Apply a hard plastic eye shield, paper cup, or plastic cup over the eye to prevent inadvertent rubbing 2
Discontinue contact lens wear until complete healing is documented by examination 2, 3
Follow-Up Strategy
Small abrasions (≤4 mm) with normal vision and improving symptoms do not require routine follow-up 6
All other patients require re-evaluation within 24 hours to assess healing and detect early infection 1, 6
Warning Signs Requiring Immediate Ophthalmology Referral
- Increasing pain, purulent discharge, or corneal infiltrate suggesting infection 2, 3, 4
- High-velocity injury or penetrating trauma 2
- Irregular pupil after trauma 2
- Eye bleeding or vision loss 2
- Symptoms not improving or worsening at 24-48 hours 6
Important Caveats
Chronic prophylactic antibiotic use promotes resistant organisms, so treatment should be time-limited to the healing period 1, 4
Prophylactic antibiotics are most effective when initiated within 24 hours of injury and have been shown to prevent ulceration when used in this timeframe 1
The evidence supporting antibiotic prophylaxis for preventing infection remains of low certainty based on a 2022 Cochrane review 8, however current guidelines strongly recommend their use given the potentially sight-threatening consequences of bacterial keratitis and the low risk profile of short-term topical antibiotics 1