What is the treatment for an eye abrasion?

Treatment of Eye Abrasion (Corneal Abrasion)

After cleaning the abrasion, apply a topical broad-spectrum antibiotic (preferably fluoroquinolone drops like moxifloxacin 0.5% four times daily) and cover with an occlusive dressing or antibiotic ointment to keep the wound moist—do not patch the eye as this delays healing and provides no pain benefit. 1, 2, 3, 4

Immediate Management

Initial Assessment and Protection

• Do not rub the eye as this worsens the injury and causes further corneal epithelial damage 1, 3
• Apply a hard plastic eye shield, paper cup, or plastic cup taped over the eye to prevent unintentional touching 1, 3
• Remove contact lenses immediately if present and discontinue use until complete healing is confirmed 1, 2

When to Seek Immediate Medical Attention

Refer urgently to ophthalmology if any of the following are present:

• High-velocity mechanism of injury (grinding, nailing, machinery) 1, 5
• Penetrating injury from sharp or metal objects 1, 5
• Irregular pupil after trauma 1, 5
• Eye bleeding or vision loss after trauma 1, 3
• Persistent foreign-body sensation despite initial treatment 1, 2

Definitive Treatment Algorithm

Step 1: Clean and Irrigate

• Irrigate the eye with large amounts of tap water or sterile saline to remove loose debris 1, 5
• Tap water is as effective as saline and is readily available 1

Step 2: Antibiotic Selection Based on Risk Category

For Simple, Non-Contact Lens Related Abrasions:

• First-line: Fluoroquinolone drops (moxifloxacin 0.5% or levofloxacin 1.5%) four times daily 2, 3
• Alternative: Bacitracin ointment 1-3 times daily if drops are not available 6
• Adjunctive: Antibiotic ointment (bacitracin or erythromycin) at bedtime for additional lubrication and protection 2, 3
• Treatment must be started within 24 hours of injury for maximum effectiveness in preventing ulceration 2, 3

For Contact Lens-Related Abrasions (Higher Risk):

• Mandatory: Fluoroquinolone drops (moxifloxacin 0.5% or gatifloxacin) four times daily—these provide anti-pseudomonal coverage 2, 3
• Never use eye patches or therapeutic contact lenses due to dramatically increased risk of bacterial keratitis 2, 3
• More aggressive monitoring required with follow-up within 24 hours 5

Step 3: Apply Occlusive Dressing

• After antibiotic application, cover with a clean occlusive dressing that keeps the wound moist and prevents drying 1
• This significantly shortens healing time compared to leaving the abrasion exposed 1
• Do NOT use an eye patch—multiple high-quality studies show patching delays healing and provides no pain benefit 3, 7, 4

Step 4: Pain Management

• First-line: Oral acetaminophen or NSAIDs (ibuprofen, naproxen) 1, 3, 5
• Adjunctive: Topical NSAIDs (ketorolac) for pain, photophobia, and foreign body sensation 5
• For severe ciliary spasm pain: Cycloplegic drops (cyclopentolate) may be considered 5, 8

Important Caveats and Pitfalls

What NOT to Do

• Avoid topical steroids initially—they delay healing and increase infection risk 3
• If steroids are needed for inflammation, only add after 2-3 days of antibiotic-only therapy 2
• Avoid eye patching—this is an outdated practice that delays healing by approximately 0.14 days and does not reduce pain 4
• Avoid chronic prophylactic antibiotic use as this promotes resistant organisms 2, 3

Special Considerations for Severe Cases

Escalate treatment immediately if any of the following develop:

• Central location or infiltrate >2mm 2
• Deep stromal involvement 2
• Presence of hypopyon 2
• Corneal stromal loss 2

Escalation protocol: Loading dose every 5-15 minutes, then hourly dosing; consider fortified antibiotics (tobramycin 1.5% + cefazolin 10%) 2

Critical Care/ICU Patients

• Patients receiving neuromuscular blockade or heavy sedation have 20-60% prevalence of corneal abrasions 1
• Begin prophylactic eye care immediately with artificial-tear ointment every 6 hours 1
• Artificial-tear ointment is more effective than passive eyelid closure in preventing exposure keratitis 1, 3
• For unconscious patients, establish a moisture chamber with polyethylene film to prevent corneal exposure 1

Follow-Up Requirements

• All patients: Monitor for signs of infection (increasing pain, purulent discharge, corneal infiltrate) 2, 3
• Contact lens wearers: Follow-up within 24-48 hours mandatory 5
• Simple abrasions: Follow-up if not improved within 48-72 hours, as most heal in this timeframe 7
• Educate patients to seek immediate care if worsening pain, vision changes, or purulent discharge develops 2, 3

Evidence Quality Note

The recommendation against eye patching is supported by moderate-certainty evidence from multiple randomized trials showing no benefit and possible harm 4. The use of prophylactic antibiotics has low to very low certainty evidence for preventing infection, but the 2024 American Heart Association guidelines strongly recommend their use based on expert consensus and the low risk of harm 1, 9. Fluoroquinolones are preferred based on FDA approval for bacterial keratitis and superior corneal penetration compared to ointments 2.