What is the treatment for corneal abrasion?

From the Guidelines

Treatment for a corneal abrasion should prioritize pain management, prevention of infection, and promotion of healing, with a focus on topical antibiotics 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 primary goal of treatment is to reduce the risk of infection and promote healing.

• Pain relief can be achieved with over-the-counter pain medications like acetaminophen or ibuprofen, and prescription eye drops containing NSAIDs such as ketorolac 0.5% applied four times daily may also help reduce pain and inflammation.
• To prevent infection, antibiotic eye drops like erythromycin ointment or fluoroquinolone drops (such as moxifloxacin or ciprofloxacin) are often prescribed, typically used 4 times daily for 5-7 days, as supported by recent studies 1.
• Lubricating eye drops or artificial tears can be applied frequently throughout the day to keep the eye moist and comfortable.
• Patients should avoid wearing contact lenses until the abrasion is fully healed and the eye doctor gives approval.
• A patch is generally no longer recommended for corneal abrasions as it may actually slow healing, and this is especially true for patients who wear contact lenses, as patching may increase the risk of bacterial keratitis 1. Most corneal abrasions heal within 24-72 hours, but follow-up with an eye care professional is important, especially if symptoms worsen or don't improve within 48 hours. The corneal epithelium has remarkable regenerative capabilities, allowing for rapid healing when proper treatment is followed and further trauma is avoided. Key considerations in treatment include:
• The use of topical antibiotics to prevent acute bacterial keratitis, especially in high-risk patients such as those who wear contact lenses or have suffered trauma 1.
• The avoidance of patching in patients who wear contact lenses due to the increased risk of bacterial keratitis 1.
• The importance of follow-up with an eye care professional to monitor healing and address any complications that may arise.

From the FDA Drug Label

Instill one drop in the affected eye 3 times a day for 7 days. ( 2) The treatment for corneal abrasion with moxifloxacin (OPHTH) is to instill one drop in the affected eye 3 times a day for 7 days 2.

From the Research

Corneal Abrasion Treatment

• Corneal abrasions are injuries that result from cutting, scratching, or abrading the thin, protective, clear coat of the exposed anterior portion of the ocular epithelium, causing pain, tearing, photophobia, foreign body sensation, and a gritty feeling 3.
• Symptoms can be worsened by exposure to light, blinking, and rubbing the injured surface against the inside of the eyelid 3.
• Most corneal abrasions heal in 24 to 72 hours and rarely progress to corneal erosion or infection 3.

Treatment Options

• Initial treatment should be symptomatic, consisting of foreign body removal and analgesia with topical nonsteroidal anti-inflammatory drugs or oral analgesics; topical antibiotics also may be used 3, 4.
• Topical mydriatics are not beneficial 3.
• Patching is not recommended because it does not improve pain and has the potential to delay healing 3, 4, 5.
• Evidence does not support the use of topical cycloplegics for uncomplicated corneal abrasions 4.

Antibiotic Prophylaxis

• The current evidence is insufficient to support any antibiotic regimen being superior to another in preventing ocular infection or accelerating epithelial healing following a corneal abrasion 6.
• Topical antibiotics are commonly prescribed to prevent bacterial superinfection, but the evidence is lacking 4.
• Contact lens-related abrasions should be treated with antipseudomonal topical antibiotics 4.

Patching for Corneal Abrasion

• People receiving a patch may be less likely to have a healed corneal abrasion after 24 hours compared to those not receiving a patch 5.
• Participants receiving a patch took slightly longer to heal but the difference was small and probably unimportant 5.
• Patching does not reduce pain in patients with corneal abrasions, and topical diclofenac does reduce pain in patients with corneal abrasions 7.