What are the recommended eye drops for treating corneal abrasions?

Recommended Eye Drops for Corneal Abrasions

Topical broad-spectrum antibiotic drops, specifically fluoroquinolones such as moxifloxacin 0.5% or gatifloxacin, are the first-line treatment for corneal abrasions to prevent secondary bacterial infection. 1, 2, 3

Primary Treatment Regimen

Antibiotic Selection and Dosing

• Fluoroquinolones (moxifloxacin 0.5% or gatifloxacin) are preferred due to their broad-spectrum coverage and FDA approval for bacterial keratitis treatment 1, 2, 3
• Apply antibiotic drops four times daily until complete epithelial healing is confirmed 2
• Treatment should be initiated within 24 hours of the abrasion for maximum effectiveness in preventing ulceration 1, 2
• Alternative options include levofloxacin 1.5%, which provides equivalent efficacy to ofloxacin with higher concentration 2

Adjunctive Ointment Therapy

• Antibiotic ointment may be applied at bedtime for additional protection and lubrication in simple, non-contact lens related abrasions 1, 3
• Chloramphenicol ointment 1% three times daily for 3 days is effective when started within 48 hours of injury in non-contact lens wearers 1
• Note that ointments lack solubility and cannot penetrate the cornea significantly, making them useful primarily as adjunctive therapy rather than monotherapy 2

Treatment Algorithm Based on Clinical Scenario

Simple Abrasions (Non-Contact Lens Wearers)

• Fluoroquinolone drops four times daily 1, 3
• Optional antibiotic ointment at bedtime 1, 3
• Oral analgesics (acetaminophen or NSAIDs) for pain control 1, 2

Contact Lens-Related Abrasions

• Mandatory topical antibiotics to prevent acute bacterial keratitis 2
• Fluoroquinolone drops are essential due to higher infection risk 2, 3
• Avoid contact lens wear until complete healing is confirmed 1, 2
• Do not use eye patches in contact lens wearers due to increased risk of bacterial keratitis 1

Severe or Central Keratitis

• Immediate escalation if infiltrate >2mm, deep stromal involvement, hypopyon present, or corneal stromal loss 2
• Loading dose every 5-15 minutes, then hourly dosing 2
• Consider fortified antibiotics (tobramycin 1.5% + cefazolin 10%) for severe cases 2

Critical Considerations and Pitfalls

What to Avoid

• Do not patch the eye - studies show patching does not improve healing and may actually hinder it 1, 3, 4
• Avoid topical steroids initially as they delay healing and increase infection risk 1, 3
• Do not use combination steroid-antibiotic drops as initial therapy; steroids should only be added after 2-3 days of antibiotic-only therapy if needed 2
• Avoid chronic use of prophylactic antibiotics as this may promote resistant organisms 1, 3

Warning Signs Requiring Immediate Follow-Up

• Increasing pain, purulent discharge, or corneal infiltrate 1, 3
• High-velocity eye injuries or penetrating trauma 2
• Irregular pupil after trauma 2
• Eye bleeding or vision loss after trauma 2

Special Situations

Delayed Healing or Persistent Defects

• For persistent epithelial defects not responding to standard treatment, consider oral doxycycline, autologous serum, or amniotic membrane application 1, 3
• Bandage contact lens may be helpful in cases of delayed healing but is generally not needed for simple abrasions 3

Pain Management

• Topical NSAIDs (such as diclofenac) can provide significant pain relief 5
• Recent consensus guidelines from the American College of Emergency Physicians suggest that for simple corneal abrasions, topical anesthetics (proparacaine, tetracaine) may be safely prescribed for use up to every 30 minutes during the first 24 hours, with no more than 1.5-2 mL total dispensed 6

Evidence Quality Note

The evidence supporting antibiotic prophylaxis in corneal abrasion shows that while antibiotics are widely recommended by guidelines 1, 2, 3, the most recent Cochrane review (2025) found very low certainty evidence regarding their effectiveness in preventing infection or accelerating healing 7. However, given the potential severity of bacterial keratitis and the low risk of short-term antibiotic use, guideline recommendations strongly favor prophylactic antibiotic use, particularly when initiated within 24 hours of injury 1, 2.