What is the recommended treatment for a healthy adult with an eye abrasion and no significant medical history?

Eye Abrasion Treatment

Recommended First-Line Treatment

For a healthy adult with an eye abrasion, prescribe topical broad-spectrum antibiotic drops (fluoroquinolones such as moxifloxacin 0.5% or ofloxacin 0.3%) four times daily, combined with oral NSAIDs or acetaminophen for pain control, and avoid eye patching. 1, 2, 3

Treatment Algorithm

Immediate Management

• Do not patch the eye – multiple studies demonstrate patching does not improve pain or healing and may actually delay recovery 2, 3, 4, 5
• Remove any foreign bodies if present before initiating treatment 4
• Confirm diagnosis with fluorescein staining showing epithelial defect under cobalt blue light 4, 5

Antibiotic Selection

• Fluoroquinolones are the preferred antibiotic class due to broad-spectrum coverage and FDA approval for bacterial keratitis treatment 1, 2, 3
• Specific options include moxifloxacin 0.5% or ofloxacin 0.3% applied four times daily 1
• Initiate antibiotics within 24 hours of injury for maximum effectiveness in preventing bacterial ulceration 1, 2
• Antibiotic ointment (such as erythromycin or polymyxin B) may be added at bedtime for additional lubrication and protection 1, 2, 6

Important caveat: While the American Academy of Ophthalmology recommends prophylactic antibiotics, a 2022 Cochrane review found very low certainty evidence for their benefit in preventing infection 7. However, given the low risk of antibiotic drops and potential severity of bacterial keratitis, prophylactic antibiotics remain standard practice 1, 2, 3.

Pain Management

• Topical NSAIDs (ketorolac tromethamine 0.5%) significantly reduce pain, photophobia, and foreign body sensation compared to placebo 6
• Oral acetaminophen or NSAIDs are reasonable alternatives for pain control 1, 2
• Avoid topical cycloplegics – evidence does not support their use for uncomplicated corneal abrasions 4

What NOT to Do

• Never use topical steroids initially – they delay healing and increase infection risk 2, 3
• Do not prescribe tetracycline ointment as monotherapy – it lacks adequate corneal penetration for optimal therapeutic benefit 1
• Avoid pressure patching – it does not improve comfort or healing speed and may hinder recovery 3, 5

Follow-Up Strategy

• Small abrasions (≤4 mm) with normal vision and resolving symptoms do not require routine follow-up 4
• All other patients should be reevaluated in 24 hours to monitor healing and detect early infection 1, 4
• Most corneal abrasions heal within 24-72 hours 5

Red Flags Requiring Immediate Ophthalmology Referral

• High-velocity eye injuries or penetrating trauma 1, 2
• Irregular pupil after trauma 1
• Eye bleeding or vision loss after trauma 1
• Signs of infection: increasing pain, purulent discharge, corneal infiltrate, or central infiltrate >2mm 1, 3
• Symptoms that worsen or fail to improve within 24-48 hours 4

Special Considerations for Contact Lens Wearers

Contact lens-related abrasions require different management:

• Prescribe fluoroquinolones with antipseudomonal coverage (mandatory due to high Pseudomonas risk) 1, 3
• Never patch the eye or use therapeutic contact lenses in contact lens wearers – this dramatically increases bacterial keratitis risk 1, 4
• Avoid all contact lens wear until complete healing is confirmed by a healthcare professional 1, 2

Common Pitfalls to Avoid

• Chronic prophylactic antibiotic use may promote resistant organisms 1, 2, 3
• Rubbing the eye worsens injury and causes further corneal damage 1, 2, 3
• Inadequate blinking or incomplete eyelid closure during sleep significantly impairs healing 1, 3
• Using combination steroid-antibiotic drops as initial therapy is contraindicated 1