Treatment of Corneal Abrasion (Eye Scratch)
For an adult with a simple corneal abrasion (eye scratch), skip the eye patch, prescribe a topical antibiotic (such as erythromycin ointment or polymyxin B) to prevent infection, and add topical ketorolac 0.5% four times daily for pain relief—most abrasions heal within 24-72 hours without complications. 1, 2
Immediate Assessment and Diagnosis
Confirm the diagnosis by applying fluorescein dye and examining the cornea under cobalt-blue filtered light to visualize the epithelial defect. 2 This simple bedside technique makes corneal abrasions immediately visible as bright green areas of dye uptake.
Rule out serious injury before proceeding with simple abrasion treatment. Refer immediately to ophthalmology if you identify: 3, 4
- Visual loss beyond mild blurriness
- Moderate to severe pain (suggests deeper injury)
- Corneal infiltrate or ulceration (white spot on cornea)
- Penetrating injury or suspicion of open globe
- Chemical exposure requiring prolonged irrigation 5
- Contact lens-related abrasion (higher infection risk)
Evidence-Based Treatment Protocol
Antibiotic Prophylaxis
Apply topical antibiotic ointment or drops to prevent secondary bacterial infection while the epithelium heals. 1, 2 Options include:
- Erythromycin ophthalmic ointment (apply thin ribbon to lower lid 3-4 times daily)
- Polymyxin B/bacitracin ointment 6, 1
- Fluoroquinolone drops if ointment not tolerated
The antibiotic choice is empiric since simple traumatic abrasions rarely become infected in immunocompetent adults. 2
Pain Management
Prescribe topical ketorolac tromethamine 0.5% ophthalmic solution one drop four times daily for symptomatic relief. 1 A high-quality randomized controlled trial demonstrated that ketorolac significantly reduced pain (P < 0.002), photophobia (P < 0.009), and foreign body sensation (P < 0.003) compared to placebo, with faster return to normal activities (P < 0.001) and no increase in complications. 1
Add oral analgesics (acetaminophen or ibuprofen) as needed for additional pain control. 2
Consider a short-acting cycloplegic drop (such as cyclopentolate 1%) for ciliary spasm relief if the patient has significant photophobia or pain, though this is optional. 1
What NOT to Do
Do not patch the eye. 1, 2 Multiple well-designed studies conclusively show that eye patching provides no benefit for healing and may actually hinder recovery while causing patient discomfort. 2 This represents a major shift from traditional practice.
Do not prescribe topical corticosteroids for simple abrasions, as they can mask infection and delay healing. 3, 5 Reserve steroids only for specific inflammatory conditions under ophthalmology supervision.
Do not use topical anesthetics beyond the initial examination, as they are toxic to the corneal epithelium and prevent healing. 2
Follow-Up and Expected Course
Most corneal abrasions heal within 24-72 hours without intervention beyond symptomatic treatment. 2
Instruct the patient to return in 3-4 days if symptoms worsen or fail to improve, as this may indicate infection, recurrent erosion, or an initially missed deeper injury. 3, 2
Warn about recurrent corneal erosion syndrome, which can develop weeks to months after the initial injury, causing episodes of pain upon awakening as the healing epithelium detaches. 2 This requires ophthalmology referral for specialized treatment.
Common Pitfalls to Avoid
Do not miss a retained foreign body. 2 Evert the upper eyelid to check the tarsal conjunctiva, as foreign bodies often lodge there and cause linear vertical corneal abrasions with each blink.
Do not assume all "scratches" are simple abrasions. 7, 4 Any history of high-velocity projectile, grinding metal, or penetrating mechanism requires careful examination to exclude intraocular foreign body or open globe injury, which demand immediate ophthalmology consultation.
Do not treat contact lens-related abrasions as simple injuries. These carry significantly higher risk of Pseudomonas infection and require fluoroquinolone coverage and ophthalmology follow-up. 2
In patients with severe chemical exposure, immediate copious irrigation with tap water for at least 15 minutes takes absolute priority over everything else, including transportation to the hospital. 5 Every second of delay worsens the prognosis for vision.