What is the treatment for a scratched cornea?

Treatment for a Scratched Cornea (Corneal Abrasion)

For a simple corneal abrasion, do not patch the eye, prescribe topical antibiotics (especially for contact lens wearers), use oral analgesics or topical NSAIDs for pain, and consider cycloplegics if significant discomfort is present. 1

Immediate First Aid Management

• Do not rub the eye under any circumstances, as this can worsen the injury 1
• Remove contact lenses immediately if the injury is associated with contact lens use, discontinue wear, and seek medical attention 1
• Protect the eye by taping a hard plastic eye shield, paper cup, or plastic cup over the eye to prevent unintentional touching 1
• For low-energy foreign bodies (dust, dirt, eyelash), it is reasonable to irrigate with tap water or commercial eye wash solution to flush out debris 1

When to Seek Immediate Medical Attention

You must seek immediate medical care if any of the following are present 1:

• High-velocity eye injury (grinding, nailing, machinery)
• Penetrating injury from sharp or metal objects
• Irregular pupil after trauma
• Eye bleeding after trauma
• Loss of vision after trauma
• Persistent foreign-body sensation that does not resolve

Medical Treatment Approach

Pain Management

• Oral analgesics (acetaminophen or NSAIDs) are the first-line approach for pain control 1, 2, 3
• Topical NSAIDs can be used for pain management and are effective 2, 3
• Cycloplegic agents (such as cyclopentolate or homatropine) should be used if significant discomfort is present, as they reduce pain from ciliary spasm 1, 4, 2

Antibiotic Therapy

• Topical antibiotics are recommended, particularly for contact lens wearers and patients with ocular foreign bodies 1, 2, 3
• Fluoroquinolones (ciprofloxacin 0.3%, ofloxacin 0.3%, or levofloxacin 1.5%) are FDA-approved for bacterial keratitis and provide excellent coverage 1
• Prophylactic antibiotics started within 24 hours of corneal abrasion may prevent progression to ulceration 1
• For contact lens wearers with traumatic abrasion, there is higher risk of secondary infectious keratitis, making antibiotic prophylaxis particularly important 1

What NOT to Do

• Do not patch the eye - multiple well-designed studies show patching does not help healing and may actually hinder it 3
• Avoid patching especially in contact lens wearers due to increased risk of secondary bacterial keratitis 1
• Do not use topical corticosteroids initially - steroids should only be added after 2-3 days of antibiotic therapy once the organism is identified and epithelial defect is healing 5

Special Considerations

Contact Lens-Related Abrasions

• Discontinue contact lens use completely until cornea returns to normal 1
• Higher risk of Pseudomonas infection, so fluoroquinolone coverage is essential 1
• Avoid bandage contact lenses due to increased risk of microbial keratitis 1

Antibiotic Dosing and Duration

• Most antibiotics should not be tapered below 3-4 times daily as lower doses are subtherapeutic and may increase antibiotic resistance 1, 5
• Taper antibiotics as infection improves, as prolonged use causes toxicity 1, 5
• If no improvement within 48 hours, modify therapy and consider reculture 1, 5

Expected Healing Timeline

• Most corneal abrasions heal within 24 to 72 hours 3
• Rarely progress to corneal erosion or infection if properly managed 3
• Follow-up is recommended for select patients, particularly those with large abrasions, contact lens wearers, or persistent symptoms 2, 3

Common Pitfalls to Avoid

• Do not prescribe combination steroid-antibiotic drops (like Tobradex) as initial monotherapy - start with antibiotics only 5
• Rule out fungal keratitis before considering any corticosteroid use, as steroids are a risk factor for requiring penetrating keratoplasty in fungal infections 5
• Avoid topical anesthetics for ongoing pain management as they delay healing and can cause corneal toxicity 1
• Do not use ointments for severe cases as they lack adequate corneal penetration 1