What is the treatment for a corneal abrasion?

Treatment of Corneal Abrasion

All patients with corneal abrasions should receive topical broad-spectrum antibiotic prophylaxis, with fluoroquinolones (moxifloxacin or gatifloxacin) as the preferred first-line agents applied 3-4 times daily for 7 days. 1, 2, 3

Antibiotic Selection and Dosing

Fluoroquinolones are the preferred antibiotics because they achieve superior corneal tissue penetration compared to ointments and have FDA approval for bacterial keratitis treatment. 1, 3, 4

• Moxifloxacin 0.5%: Instill one drop in the affected eye 3 times daily for 7 days 5
• Alternative fluoroquinolones: Gatifloxacin, levofloxacin 1.5%, ciprofloxacin 0.3%, or ofloxacin 0.3% 1, 2
• Antibiotic ointment at bedtime may be added for additional lubrication and protection, though drops are preferred for primary therapy 1, 2, 3

Critical timing: Prophylactic antibiotics are most effective when started within 24 hours of injury to prevent ulceration and secondary infection. 1, 3

Risk-Stratified Treatment Algorithm

Simple Traumatic Abrasions (Non-Contact Lens Wearers)

• Fluoroquinolone drops 4 times daily for 7 days 2, 3, 4
• Oral analgesics (acetaminophen or NSAIDs) for pain control 2, 3
• Optional: Antibiotic ointment at bedtime 2, 4

Contact Lens-Related Abrasions (HIGH RISK)

• More aggressive antipseudomonal coverage required with fluoroquinolone drops applied more frequently 1, 3
• Absolutely avoid eye patching due to significantly increased risk of bacterial keratitis 1
• Avoid bandage contact lenses in the acute setting due to infection risk 1
• Discontinue all contact lens wear until complete healing confirmed by examination 3

Post-Trauma Abrasions

• Broad-spectrum topical antibiotic recommended to prevent both bacterial AND fungal infection 1
• Same fluoroquinolone regimen as simple abrasions 2, 3

Pain Management

• Oral analgesics preferred: Acetaminophen or NSAIDs 2, 3
• Topical NSAIDs may be used for pain relief 6, 7
• Avoid topical cycloplegics for uncomplicated abrasions as evidence does not support benefit 7
• Cycloplegics only indicated when substantial anterior chamber inflammation is present 1

Critical Management Principles

What NOT to Do

Eye patching is contraindicated - multiple well-designed studies demonstrate patching does not improve pain or healing and may actually delay recovery. 1, 2, 4, 6, 7

Avoid topical steroids initially - they delay healing and increase infection risk. 2, 4

Do not use tetracycline ointment as monotherapy - inadequate corneal penetration compared to fluoroquinolone drops. 3

Important Caveats

• Chronic prophylactic antibiotic use promotes resistant organisms - limit duration to necessary treatment period only 1, 2, 3, 4
• Inadequate blinking or incomplete eyelid closure delays healing - consider temporary tarsorrhaphy with botulinum toxin or suture if present 3, 4
• Rubbing the eye worsens injury - counsel patients to avoid this 2, 4

Follow-Up and Warning Signs

Follow-Up Timing

• Small abrasions (≤4 mm) with normal vision and resolving symptoms: Follow-up may not be necessary 7
• All other patients: Re-evaluate in 24 hours 7
• Contact lens wearers: Mandatory follow-up to confirm healing before resuming lens wear 3

Red Flags Requiring Immediate Ophthalmology Referral

• Increasing pain despite treatment 2, 3, 4
• Purulent discharge suggesting infection 2, 3, 4
• Corneal infiltrate or ulcer development 4, 7
• Significant vision loss 7
• Any suspicion of penetrating eye injury 7, 8

Special Situations: Persistent Epithelial Defects

If healing is delayed beyond expected 24-72 hours despite standard treatment: 6

• Consider bandage contact lens (only after acute phase and with continued antibiotic coverage) 1, 4
• Amniotic membrane application for persistent defects 3, 4
• Autologous serum drops 3, 4
• Cenegermin (nerve growth factor) 20 μg/ml for neurotrophic keratopathy 3, 4
• Oral doxycycline for persistent cases 4

Evidence Quality Note

While the 2024 American Academy of Ophthalmology Bacterial Keratitis Preferred Practice Pattern strongly recommends prophylactic antibiotics for corneal abrasions (particularly contact lens-related and traumatic), 1 a 2022 Cochrane review found only very low certainty evidence for infection prevention benefit. 9 However, given the potentially sight-threatening consequences of secondary bacterial keratitis and the low risk of short-term antibiotic use, the guideline recommendation for prophylaxis remains the standard of care. 1