What is the treatment for a female with a corneal abrasion (A-corneal abrasion) confirmed by a positive fluorescein dye test after using sandpaper?

Treatment of Corneal Abrasion from Sandpaper Injury

For this patient with a fluorescein-confirmed corneal abrasion from sandpaper, initiate topical antibiotic prophylaxis (moxifloxacin four times daily), provide pain control with oral NSAIDs or acetaminophen, avoid eye patching, and ensure ophthalmology follow-up within 24 hours. 1

Immediate Management Steps

Foreign Body Removal and Eye Irrigation

• Remove any visible foreign material if present on the ocular surface; if embedded in the cornea, refer immediately to ophthalmology for removal 1
• Irrigate the eye thoroughly with sterile saline or commercial eye wash solution to flush out any loose sandpaper particles or debris 2, 1
• Instruct the patient not to rub the eye, as this can worsen the epithelial defect and increase risk of infection 2

Antibiotic Prophylaxis

• Apply broad-spectrum topical antibiotic drops such as moxifloxacin four times daily to prevent bacterial superinfection 2, 1
• The evidence for antibiotic prophylaxis in preventing infection is uncertain 3, but it remains standard practice given the low risk of treatment and potential sight-threatening consequences of infection 4, 5
• Alternative topical antibiotics include erythromycin ointment or bacitracin ointment if fluoroquinolones are unavailable 6, 7
• Note: The utility of routine antibiotic prophylaxis is unclear based on recent systematic reviews, but given the traumatic mechanism (sandpaper) and potential for contamination, prophylaxis is reasonable 2, 3

Pain Management

First-Line Analgesia

• Prescribe oral acetaminophen or NSAIDs (such as ibuprofen) for pain relief 2, 1
• Consider topical NSAIDs such as ketorolac tromethamine ophthalmic solution, which significantly decreases pain, photophobia, and foreign body sensation 1, 8

Adjunctive Pain Control

• Cycloplegic agents (e.g., cyclopentolate 1%) may be used to decrease pain from ciliary spasm and anterior segment inflammation, though evidence for routine use in uncomplicated abrasions is limited 1, 4
• Do NOT patch the eye, as multiple well-designed studies demonstrate that patching does not improve pain and may delay healing 8, 4, 9

Eye Protection

• Tape a hard plastic eye shield, paper cup, or plastic cup over the eye to prevent unintentional touching or rubbing during the healing period 2

Follow-Up and Red Flags

Routine Follow-Up

• Schedule ophthalmology evaluation within 24 hours for all patients except those with very small abrasions (≤4 mm), normal vision, and rapidly resolving symptoms 4
• Most corneal abrasions heal within 24-72 hours 8, 9

Immediate Ophthalmology Referral Required If:

• Persistent foreign body sensation despite irrigation suggests retained foreign material 2
• High-velocity mechanism of injury (sandpaper on power tools, grinding) raises concern for penetrating injury 2, 1
• Irregular pupil, eye bleeding, or vision loss after trauma indicates potential globe penetration 2
• Symptoms worsen or fail to improve within 24 hours 4
• Development of corneal infiltrate or ulcer on examination 4

Common Pitfalls to Avoid

• Avoid eye patching: This outdated practice does not reduce pain and may hinder epithelial healing 8, 4
• Do not overlook embedded foreign bodies: Sandpaper particles can become embedded in the corneal stroma and require slit-lamp examination and removal by an ophthalmologist 1, 4
• Do not assume all abrasions are simple: High-velocity or sharp object mechanisms require careful evaluation for penetrating injury 2
• Topical corticosteroids should be used with extreme caution in the presence of corneal epithelial defects, as they can mask signs of infection and delay healing 2