What is the treatment for corneal abrasion?

Treatment of Corneal Abrasion

Topical fluoroquinolone antibiotic drops (moxifloxacin or gatifloxacin) applied 4 times daily are the first-line treatment for corneal abrasions to prevent secondary bacterial infection. 1, 2, 3

Primary Treatment Algorithm

Standard Non-Contact Lens Related Abrasions

• Apply fluoroquinolone drops (moxifloxacin or gatifloxacin) 4 times daily as the primary treatment, preferably started within 24 hours of injury for maximum effectiveness 1, 3
• Fluoroquinolones are preferred because they achieve superior corneal tissue penetration compared to ointments and have FDA approval for bacterial keratitis 3
• Add antibiotic ointment at bedtime for additional protection and lubrication if desired 1, 2
• Chloramphenicol ointment 1% three times daily for 3 days is an alternative when started within 48 hours of injury 1

Contact Lens Related Abrasions

• Use more aggressive antipseudomonal coverage with fluoroquinolone drops at higher frequency due to increased risk of Pseudomonas infection 3, 4
• Discontinue all contact lens wear until complete healing is confirmed by examination 1, 3
• Never patch the eye in contact lens wearers as this significantly increases the risk of bacterial keratitis 1

Pain Management

• Prescribe oral acetaminophen or NSAIDs for pain control 1, 3
• Topical NSAIDs may also be used for pain relief 5, 4
• Avoid topical cycloplegics as evidence does not support their use for uncomplicated corneal abrasions 4

Critical Interventions to AVOID

• Do NOT patch the eye - multiple studies demonstrate patching does not improve pain or healing and may actually delay recovery 1, 2, 5, 4
• Do NOT use topical steroids initially as they delay healing and increase infection risk 1, 2
• Avoid tetracycline ointment as monotherapy due to inadequate corneal penetration 3

Follow-Up and Warning Signs

Routine Follow-Up

• Small abrasions (≤4 mm) with normal vision and resolving symptoms may not require follow-up 4
• All other patients should be reevaluated in 24 hours to assess healing 4
• Most corneal abrasions heal within 24-72 hours 5

Red Flags Requiring Immediate Ophthalmology Referral

• Increasing pain or worsening symptoms 1, 2, 3
• Purulent discharge or corneal infiltrate suggesting infection 1, 2, 3
• Vision loss 1
• Symptoms not improving or worsening at 24-hour follow-up 4

Special Situations and Delayed Healing

Persistent Epithelial Defects (5-7 days or longer)

• Consider bandage contact lens for delayed healing, though not needed for simple abrasions 2, 3
• Oral doxycycline, autologous serum drops, or amniotic membrane application may be beneficial 1, 2, 3
• Cenegermin (nerve growth factor) 20 μg/ml for neurotrophic keratopathy 3

Inadequate Eyelid Function

• Temporary tarsorrhaphy with botulinum toxin or suture if inadequate blinking or incomplete eyelid closure is delaying healing 2, 3
• Adequate blinking during waking hours and complete eyelid closure during sleep are critical for healing 2, 3

Important Caveats

• Prophylactic antibiotics are most effective within 24 hours of the abrasion 1, 3
• Chronic prophylactic antibiotic use promotes resistant organisms - limit duration appropriately 1, 2, 3
• Rubbing the eye worsens the injury and should be avoided 1, 2
• Healing may be delayed in patients with underlying corneal pathology 3