Topical Antibiotic Eye Drops for Corneal Abrasion
For corneal abrasions, use topical fluoroquinolone antibiotic drops (moxifloxacin or gatifloxacin) applied 4 times daily as first-line treatment to prevent secondary bacterial infection. 1, 2
Primary Treatment Algorithm
Fluoroquinolones are the preferred antibiotic class because they achieve superior corneal tissue penetration compared to ointments and have FDA approval for bacterial keratitis treatment. 2 Specifically:
- Apply moxifloxacin or gatifloxacin drops 4 times daily starting within 24 hours of injury for maximum prophylactic benefit 1, 2
- Ofloxacin is an acceptable alternative fluoroquinolone option 3
- Antibiotic ointment may be added at bedtime for additional overnight protection 1
Risk-Stratified Approach
For simple, non-contact lens related abrasions:
- Standard fluoroquinolone drops 4 times daily are sufficient 2
- Treatment typically continues until complete epithelial healing (usually 24-72 hours) 4
For contact lens-related abrasions:
- More aggressive antipseudomonal coverage is mandatory due to higher infection risk 2, 5
- Use fluoroquinolone drops more frequently (consider hourly dosing initially for severe cases) 3
- Absolutely discontinue contact lens wear until examination confirms complete healing 2
- Tobramycin (aminoglycoside) is an alternative specifically for contact lens-related injuries 5
Critical Timing Considerations
Prophylactic antibiotics are most effective when initiated within 24 hours of the abrasion, as this timing prevents progression to corneal ulceration. 2, 3 The American Academy of Ophthalmology emphasizes this narrow therapeutic window for optimal infection prevention. 1
Adjunctive Pain Management
For symptomatic relief, use:
- Oral acetaminophen or NSAIDs for systemic pain control 2
- Topical ketorolac 0.5% (NSAID drops) significantly reduces pain, photophobia, and foreign body sensation within 24 hours 6
- Short-term topical anesthetics (tetracaine, proparacaine) may be dispensed for home use—up to 1.5-2 mL total, used every 30 minutes as needed for the first 24 hours only, then discarded 7
What NOT to Do: Common Pitfalls
Avoid eye patching entirely—multiple studies demonstrate it does not improve healing and may actually hinder recovery. 1, 4 The American Academy of Ophthalmology explicitly recommends against this outdated practice. 1
Do not use topical corticosteroids initially, as they delay epithelial healing and increase infection risk. 1
Do not use tetracycline ointment as monotherapy because it lacks adequate corneal penetration compared to fluoroquinolone drops. 2
Avoid bandage contact lenses for simple abrasions—they are unnecessary for routine cases and increase infection risk, though they may be considered for delayed healing after 5-7 days. 1, 2
Warning Signs Requiring Immediate Ophthalmology Referral
Contact ophthalmology emergently if:
- Increasing pain despite treatment 1, 2
- Purulent discharge suggesting bacterial keratitis 1, 2
- Corneal infiltrate visible on examination 1
- No improvement or worsening after 24-48 hours 2
Special Considerations for Delayed Healing
If the abrasion persists beyond 5-7 days despite appropriate antibiotic therapy:
- Consider underlying corneal pathology or inadequate eyelid closure 2
- Evaluate blinking adequacy during waking hours and complete lid closure during sleep 1, 2
- Options for persistent defects include bandage contact lens, autologous serum drops, or amniotic membrane application 1, 2
- For neurotrophic keratopathy, cenegermin (nerve growth factor) 20 μg/ml may be effective 2
Resistance Concerns
Be aware that fluoroquinolone resistance is increasing, particularly in patients with recent fluoroquinolone use, hospitalization, advanced age, or recent ocular surgery. 3 However, fluoroquinolones remain first-line due to their superior efficacy profile and broad-spectrum coverage. 1, 2
Chronic prophylactic antibiotic use promotes resistant organisms, so limit treatment duration to the healing period only. 1, 2