Treatment of Corneal Abrasion
Topical broad-spectrum antibiotic drops are the first-line treatment for corneal abrasions, with fluoroquinolones (moxifloxacin or gatifloxacin) preferred due to their superior corneal penetration and FDA approval for bacterial keratitis. 1, 2
Initial Management Approach
Antibiotic Selection and Dosing
- Apply fluoroquinolone drops 4 times daily as the primary treatment to prevent secondary bacterial infection, particularly when started within 24 hours of injury 1, 2
- Antibiotic ointment (such as erythromycin or bacitracin) may be added at bedtime for additional lubrication and protection in simple, non-contact lens related abrasions 1, 2
- Avoid tetracycline ointment as monotherapy because it lacks adequate corneal penetration compared to drops 3
The American Academy of Ophthalmology specifically recommends topical antibiotic drops over ointments because drops achieve higher tissue levels in the cornea 3. While older literature suggested various options, the most recent guidelines clearly favor fluoroquinolones for their broad-spectrum coverage 1, 2.
Pain Management
- Use over-the-counter oral acetaminophen or NSAIDs for pain control 1, 2
- Topical NSAIDs may be considered for additional pain relief 4, 5
- Avoid topical cycloplegics in uncomplicated abrasions as evidence does not support their routine use 5
What NOT to Do
- Do not patch the eye - multiple studies demonstrate patching does not improve pain and may delay healing 6, 1, 2
- Avoid topical steroids initially as they delay healing and increase infection risk 1, 2
- Do not rub the eye as this worsens injury and causes further epithelial damage 1, 3
Treatment Algorithm Based on Risk Factors
Simple Non-Contact Lens Related Abrasions
- Fluoroquinolone drops 4 times daily 1, 2
- Optional antibiotic ointment at bedtime 1, 2
- Oral analgesics as needed 1, 2
- Follow-up only if symptoms worsen or fail to improve within 24-48 hours 5
Contact Lens Related Abrasions (Higher Risk)
- More aggressive treatment with frequent antipseudomonal antibiotic drops (fluoroquinolones preferred) 1, 2, 5
- Absolutely no eye patching or therapeutic contact lens use due to significantly increased risk of bacterial keratitis 1, 2, 3
- Discontinue contact lens wear until complete healing confirmed by examination 1, 2
- Mandatory follow-up in 24 hours 5
Contact lens-related abrasions carry substantially higher infection risk and require antipseudomonal coverage, making fluoroquinolones the clear choice 3, 5.
Critical Timing Considerations
- Prophylactic antibiotics are most effective when started within 24 hours of the abrasion 1, 2, 3
- Most corneal abrasions heal within 24-72 hours with appropriate treatment 4, 7
- Healing may be delayed (5-7 days) in cases with underlying corneal pathology 6
Important Caveats and Warning Signs
Factors That Delay Healing
- Inadequate blinking or incomplete eyelid closure during sleep - assess and consider temporary tarsorrhaphy if present 6, 2
- Chronic prophylactic antibiotic use may promote resistant organisms 1, 2, 3
Red Flags Requiring Immediate Ophthalmology Referral
- Increasing pain or purulent discharge suggesting infection 1, 2, 3
- Corneal infiltrate or ulcer development 1, 5
- Vision loss 3, 5
- High-velocity injury or penetrating trauma 1, 3
- Irregular pupil after trauma 3
- Symptoms not improving or worsening at 24-hour follow-up 5
Special Situations
Persistent or Recurrent Defects
If the epithelial defect fails to heal with standard treatment, consider 6: