What is the treatment for a corneal abrasion (scratch) caused by a dog?

Treatment of Corneal Abrasion from Dog Scratch

For a corneal abrasion caused by a dog scratch, immediately irrigate the eye with large volumes of tap water or sterile saline, apply a broad-spectrum topical antibiotic (such as moxifloxacin drops four times daily), provide oral analgesics for pain control, and avoid eye patching. 1, 2

Immediate Management Steps

Eye Irrigation

• Irrigate the eye immediately with continuous, large volumes of clean tap water or sterile saline to flush out any debris, saliva, or contaminants from the dog's paw 3
• Tap water is as effective as sterile saline for irrigation and should be used without delay 3
• Continue irrigation until the eye is thoroughly cleansed 1

Foreign Body Removal

• Examine the eye carefully under good lighting to identify any embedded foreign material (hair, dirt, debris) 1
• Remove any visible foreign body if superficial and accessible 1
• If the foreign body is embedded or difficult to remove, refer immediately to an ophthalmologist 1

Antibiotic Prophylaxis

• Apply broad-spectrum topical antibiotic drops as prophylaxis against infection 1, 2
• Fluoroquinolones (moxifloxacin or gatifloxacin) are preferred due to their broad-spectrum coverage, including coverage against Pasteurella species commonly found in dog saliva and on paws 2, 3
• Dosing: Apply moxifloxacin drops four times daily 3, 1
• Consider antibiotic ointment at bedtime for additional protection and lubrication 2
• Dog scratches carry polymicrobial contamination with an average of 5 different aerobic and anaerobic bacteria, including Staphylococcus aureus, Pasteurella species, and anaerobes 3

Pain Management

• Oral analgesics (acetaminophen or NSAIDs) are first-line for pain control 1, 2
• Topical NSAIDs (ketorolac tromethamine) can significantly decrease pain, photophobia, and foreign body sensation 1
• Cycloplegic agents (cyclopentolate) may be used to decrease pain from ciliary spasm and reduce discomfort from accommodation 1

Wound Care

• After cleaning, apply an occlusive dressing or topical antibiotic that keeps the wound moist if there is periocular skin involvement 3
• Do NOT patch the eye - multiple studies show patching does not improve healing and may delay recovery 2, 4

Critical Considerations for Dog-Related Injuries

Infection Risk Assessment

• Dog scratches to the eye carry higher infection risk than simple traumatic abrasions due to polymicrobial contamination 3
• The depth and severity of the wound determine whether oral antibiotics are needed in addition to topical therapy 3
• Prophylactic antibiotics are most effective when started within 24 hours of the injury 2, 5

Rabies Consideration

• Assess the dog's vaccination status and behavior 3
• Contact local animal control or public health authorities if rabies exposure is a concern 3
• Irrigation is supported for bite wounds to reduce rabies transmission risk 3

Indications for Immediate Ophthalmology Referral

Refer immediately if any of the following are present: 1

• Penetrating eye injury or suspicion of intraocular foreign body
• High-velocity mechanism of injury
• Vision loss or significant visual impairment
• Large or deep corneal laceration (not just superficial abrasion)
• Central corneal involvement with significant infiltrate
• Signs of infection developing (worsening pain, purulent discharge, expanding infiltrate)

Follow-Up and Monitoring

• Regular follow-up is necessary to monitor healing and detect early signs of infection 2
• Most corneal abrasions heal within 24 to 72 hours 4
• Educate patients about infection warning signs: increasing pain, worsening redness, purulent discharge, decreased vision 2
• Instruct patient to seek immediate care if symptoms worsen rather than improve 2

Important Pitfalls to Avoid

• Do NOT rub the eye - this can worsen the injury and drive contaminants deeper 2
• Do NOT use topical steroids initially - they delay healing and increase infection risk 2
• Do NOT patch the eye - this does not improve outcomes and may increase infection risk 2, 4
• Do NOT delay antibiotic prophylaxis - effectiveness decreases significantly after 24 hours 2, 5
• Place an Elizabethan collar equivalent (protective eyewear or shield) to prevent the patient from rubbing or further traumatizing the eye 6