What is the treatment for a corneal abrasion caused by a tree branch?

Treatment of Tree Branch Corneal Abrasion

Treat with topical broad-spectrum antibiotic drops (preferably fluoroquinolones like moxifloxacin or gatifloxacin) 4 times daily, oral NSAIDs or acetaminophen for pain, and avoid eye patching. 1, 2

Immediate Management

Do Not Do These Things

• Do not rub the eye as this worsens the injury and causes further corneal damage 3, 1
• Do not patch the eye as multiple studies demonstrate patching does not improve healing and may actually hinder it 2, 4, 5
• Do not use topical steroids initially as they delay healing and increase infection risk 1, 2

Protective Measures

• Apply a hard plastic eye shield, paper cup, or plastic cup taped over the eye to prevent unintentional touching or rubbing 3, 6
• This is particularly important for tree branch injuries which can be contaminated 3

Antibiotic Therapy (Primary Treatment)

First-Line Antibiotic Selection

• Prescribe topical fluoroquinolone drops (moxifloxacin or gatifloxacin) 4 times daily as the preferred treatment due to broad-spectrum coverage and FDA approval for bacterial keratitis 1, 2
• These are superior to tetracycline ointment because drops achieve high corneal tissue levels, while ointments lack adequate corneal penetration 6
• Add antibiotic ointment at bedtime for additional protection and lubrication 1, 2
• Start antibiotics within 24 hours of injury for maximum effectiveness in preventing bacterial ulceration 1, 6

Rationale for Aggressive Antibiotic Coverage

Tree branch injuries carry higher contamination risk from organic material, making prophylactic antibiotics essential to prevent secondary bacterial infection 1, 2

Pain Management

Effective Pain Control Options

• Prescribe oral NSAIDs (ibuprofen) or acetaminophen for systemic pain relief 3, 1, 6
• Consider topical NSAIDs (ketorolac 0.5%) which significantly reduce pain at 24 hours and 48 hours compared to placebo 7, 8
• Topical NSAIDs also reduce photophobia and foreign body sensation within 24 hours 8
• Topical NSAIDs decrease oral analgesic use by 53% 7

Avoid Ineffective Treatments

• Cycloplegic drops are not beneficial for simple abrasions unless substantial anterior chamber inflammation is present 6, 4, 7

Follow-Up and Warning Signs

Mandatory Follow-Up Criteria

• Seek immediate medical attention if persistent foreign-body sensation continues beyond initial treatment 3, 6
• Immediate ophthalmology referral required for:
  • Irregular pupil after trauma 3, 6
  • Eye bleeding or vision loss 3, 6
  • Signs of infection: increasing pain, purulent discharge, or corneal infiltrate 6, 2
  • No improvement after 24-48 hours 1, 6

Expected Healing Timeline

• Most simple corneal abrasions heal within 24-72 hours 4
• Regular follow-up is necessary to monitor healing and detect early infection 1, 6

Special Considerations for Tree Branch Injuries

High-Risk Features Requiring Urgent Ophthalmology Consultation

Tree branch injuries can cause penetrating trauma, so evaluate carefully for:

• High-velocity mechanism of injury 3
• Penetrating eye injury from sharp branch fragments 3
• Any suspicion of intraocular foreign body 3

Tetanus Prophylaxis

Consider tetanus prophylaxis for contaminated organic material injuries like tree branches 9

Common Pitfalls to Avoid

• Chronic antibiotic use promotes resistant organisms - limit prophylactic antibiotics to the healing period only 1, 2
• Inadequate blinking or incomplete eyelid closure delays healing - ensure patients understand proper eye care 1, 2
• Contact lens wear must be avoided until complete healing is confirmed by a healthcare professional 1, 6
• Pressure patching increases complication risk and provides no benefit 7, 5