What is the treatment for corneal abrasion?

From the Guidelines

To treat a corneal abrasion, topical antibiotics should be prescribed to prevent acute bacterial keratitis, especially in patients who wear contact lenses or have suffered trauma, as recommended by the most recent guidelines 1. The treatment of corneal abrasion involves a multi-faceted approach to promote healing, prevent infection, and manage pain.

Key Considerations

• Pain management using over-the-counter pain relievers like acetaminophen or ibuprofen is essential to keep the patient comfortable.
• Lubricating eye drops or artificial tears should be applied every few hours to keep the eye moist and promote healing.
• Avoiding rubbing the eye is crucial to prevent further irritation and potential infection.
• For patients with contact lens-associated abrasion or those who have suffered trauma, topical antibiotics such as broad-spectrum topical antibiotics should be prescribed to prevent acute bacterial keratitis, as highlighted in the bacterial keratitis preferred practice pattern 1.

Prevention of Infection

• The use of prophylactic topical antibiotics in patients with chronic epithelial defects is controversial due to the risk of promoting growth of resistant organisms 1.
• However, in the context of corneal abrasion, especially following trauma or in contact lens wearers, the benefits of prophylactic antibiotics in preventing infection outweigh the risks, as evidenced by the recommendation to start treatment within 24 hours of the abrasion 1.

Monitoring and Follow-Up

• Patients should be monitored closely for signs of infection, such as increased pain, discharge, or worsening vision, and seek immediate medical attention if these symptoms occur or do not improve within 24 hours.
• The majority of corneal abrasions heal within 24-72 hours, but proper treatment and follow-up are essential to prevent complications like infection or scarring 1.

From the Research

Treatment Options for Corneal Abrasion

• The primary goals of treatment include pain control, prevention of infection, and healing 2.
• Pain relief may be achieved with topical nonsteroidal anti-inflammatory drugs or oral analgesics 3, 2.
• Topical antibiotics may be used to prevent bacterial superinfection, although evidence is lacking 2.
• Contact lens-related abrasions should be treated with antipseudomonal topical antibiotics 2.

Use of Eye Patching

• Eye patching is not recommended as it does not improve pain and has the potential to delay healing 3, 4.
• Studies have shown that patching does not help and may hinder healing 3.

Comparison of Treatment Modalities

• A prospective, randomized study compared three different treatment modalities for traumatic corneal abrasions: pressure patching with ofloxacin ointment, therapeutic contact lens with ofloxacin eye drops, and ofloxacin ointment alone 5.
• The study found that treating traumatic corneal abrasions by pressure patching, a bandage contact lens, or ointment alone was equal in reducing the abrasion area or reducing pain 5.

Antibiotic Prophylaxis

• A review of the current evidence regarding antibiotic prophylaxis in traumatic corneal abrasion found that the beneficial effects of antibiotic prophylaxis in preventing ocular infection or accelerating epithelial healing remain unclear 6.
• The review concluded that there is a need for a well-designed randomized controlled trial assessing the efficacy and safety of ocular antibiotics in the treatment of corneal abrasion 6.