What is the treatment for a corneal tear?

Treatment of Corneal Tears (Corneal Abrasions)

For corneal tears (abrasions), initiate topical broad-spectrum antibiotic prophylaxis immediately, provide pain control with topical NSAIDs or oral analgesics, and reserve bandage contact lenses only for cases with delayed healing or severe discomfort—avoiding them entirely in contact lens wearers due to increased Pseudomonas infection risk. 1, 2

Immediate Assessment and Initial Management

First-Line Treatment

• Apply topical antibiotic drops or ointment to prevent secondary bacterial infection, selecting agents based on conjunctival flora and patient immune status 3
• Bacitracin ophthalmic ointment is FDA-approved for superficial ocular infections involving the cornea 4
• Do NOT use eye patching—multiple well-designed studies demonstrate patching does not accelerate healing and may actually hinder it 5, 1
• Provide analgesia with topical NSAIDs (such as diclofenac) or oral analgesics for symptomatic relief 5, 6

Critical Contraindications

• Never use bandage contact lenses in contact lens wearers with traumatic abrasions due to significantly elevated risk of Pseudomonas keratitis 1, 2
• Immediately discontinue contact lens wear if the patient is a contact lens wearer and initiate fluoroquinolone antibiotic therapy instead 2

Bandage Contact Lens Therapy (When Indicated)

Appropriate Indications

Bandage contact lenses should be reserved for specific situations 1:

• Persistent epithelial defects not responding to standard antibiotic treatment
• Delayed healing beyond 24-72 hours
• Severe discomfort from microcystic or bullous epithelial disease
• NOT needed for simple, uncomplicated corneal abrasions 1

Lens Specifications

When bandage contact lenses are indicated 3, 1:

• Use thin lenses with high water content
• Require high oxygen diffusion coefficients (high Dk levels) to minimize hypoxia risk
• Fit should be flat with some movement on blinking to allow tear exchange
• Consider preservative-free artificial tears if concomitant dry eye exists to facilitate lens movement 3

Mandatory Concurrent Therapy

• Always prescribe topical prophylactic broad-spectrum antibiotic when using bandage contact lenses to decrease infection risk 3, 1
• Replace lens periodically—same lens should not remain on eye longer than one month 3

Patient Education Requirements

Patients must be explicitly warned about 3, 1:

• Risk of infectious keratitis with bandage contact lens wear
• Need to immediately contact ophthalmologist if redness, pain, or increased photophobia develops
• Requirement for regular follow-up to reassess lens and monitor complications

Special Circumstances

Contact Lens-Related Abrasions

For suspected bacterial keratitis in contact lens wearers 2:

• Immediately discontinue contact lens wear
• Do NOT patch or use therapeutic contact lens
• Initiate empiric topical fluoroquinolone monotherapy (ciprofloxacin 0.3%, ofloxacin 0.3%, or levofloxacin 1.5%)
• Dose every 1-2 hours while awake for first 48 hours 2
• Add cycloplegic drops to decrease synechiae formation and reduce pain from anterior chamber inflammation 2

Persistent or Recurrent Erosions

For cases not responding to initial therapy 3:

• Consider amniotic membrane transplantation (self-retaining or under bandage contact lens) for anti-inflammatory and prohealing effects 3
• Autologous serum, cord blood tears, or platelet-rich plasma have demonstrated benefits for persistent defects 3
• Oral doxycycline may inhibit matrix metalloproteinases in delayed healing 3

Corneal Thinning or Perforation Risk

If progressive thinning develops 3:

• Apply cyanoacrylate tissue adhesive to small areas of marked thinning or early descemetocele
• Base must be dry and de-epithelialized for adhesive to adhere properly 3
• Use minimal amount necessary to seal defect 3
• Apply bandage contact lens over adhesive to prevent dislocation and provide comfort 3

Common Pitfalls to Avoid

• Avoid pressure patching—this outdated practice does not improve healing and may worsen outcomes 5, 1
• Do not use bandage contact lenses as first-line therapy for simple abrasions 1
• Never use bandage contact lenses in contact lens wearers with traumatic abrasions 1, 2
• Avoid topical corticosteroids initially unless infection is ruled out or controlled; they should only be added after 2-3 days of antibiotic therapy once organism is identified 7
• Monitor for steroid responsiveness and elevated IOP with long-term corticosteroid use 3

Follow-Up Protocol

• Reassess within 24-48 hours to evaluate treatment response 2
• Most corneal abrasions heal within 24-72 hours with appropriate treatment 5
• If no improvement within 48 hours, modify therapy and consider reculture 7, 2
• Regular follow-up is mandatory when bandage contact lenses are used to monitor for complications 3, 1