Treatment of Traumatic Corneal Abrasion with Secondary Bacterial Conjunctivitis
This patient requires immediate treatment with a broad-spectrum topical antibiotic for 5-7 days to prevent progression to bacterial keratitis, given the purulent discharge indicating bacterial superinfection of the traumatic corneal abrasion. 1
Immediate Management
Rule Out Serious Complications First
- Check visual acuity immediately - any vision loss requires same-day ophthalmology referral 2, 3
- Examine the cornea carefully - look for corneal opacity, infiltrate, or ulceration which indicates keratitis requiring urgent ophthalmology consultation 1, 2
- Assess pain severity - moderate to severe pain not relieved by topical anesthetics requires ophthalmology referral 3, 4
Antibiotic Treatment
Start a 5-7 day course of broad-spectrum topical antibiotic immediately. 1, 2 The American Academy of Ophthalmology states that no specific antibiotic has proven superiority, so choose the most convenient or least expensive option such as:
- Fluoroquinolones (moxifloxacin, ciprofloxacin)
- Polymyxin B/trimethoprim
- Erythromycin ointment 1
The presence of purulent discharge with a traumatic mechanism (fingernail scratch) indicates moderate bacterial conjunctivitis with risk of corneal involvement, making antibiotic therapy essential rather than optional. 1, 2
Supportive Care
- Preservative-free artificial tears 4 times daily for comfort and to facilitate healing 2, 3
- Avoid contact lens wear during treatment if the patient is a contact lens wearer 2
- Cold compresses may provide symptomatic relief 2
Critical Follow-Up
Re-evaluate in 3-4 days if no improvement. 1, 2 At follow-up, reassess:
- Visual acuity
- Corneal clarity and epithelial healing
- Discharge character and amount
- Pain level 1
Red Flags Requiring Immediate Ophthalmology Referral
Refer urgently if any of the following develop:
- Visual loss or decreased vision 2, 3
- Corneal opacity or infiltrate (suggests bacterial keratitis) 1, 2, 3
- Severe or worsening pain 2, 3
- Lack of improvement after 3-4 days of treatment 2, 3
- Recurrent episodes 2
Special Considerations for Fingernail Injuries
Fingernail-induced corneal abrasions carry specific risks:
- Higher risk of complications when the injury involves adult-to-adult scratches 5
- Risk of recurrent erosion syndrome developing months later 5
- Potential for bacterial contamination from under the fingernail, making antibiotic prophylaxis particularly important 5
Common Pitfalls to Avoid
- Do not use topical corticosteroids without ophthalmology consultation, as they can worsen bacterial or herpes simplex infections and increase intraocular pressure 2
- Do not assume this is simple viral conjunctivitis - the traumatic mechanism with purulent discharge indicates bacterial infection requiring antibiotics 1, 2
- Do not delay treatment - corneal abrasions with bacterial superinfection can rapidly progress to sight-threatening keratitis 1, 4, 6
- Do not use bandage contact lenses without concurrent antibiotic prophylaxis due to infection risk 1