From the Guidelines
Topical antibiotics should be prescribed to prevent acute bacterial keratitis in patients who wear contact lenses and present with a corneal abrasion, as well as for any patient presenting with corneal abrasion following trauma, to prevent not only bacterial infection but also fungal infection. A corneal abrasion is a scratch or injury to the clear front surface of the eye (cornea) [ 1 ]. Treatment typically involves antibiotic eye drops such as erythromycin ointment or fluoroquinolone drops (like ciprofloxacin or moxifloxacin) to prevent infection, applied 4 times daily for 3-5 days.
Key Considerations
- Pain management includes oral pain relievers like acetaminophen or ibuprofen, and sometimes cycloplegic eye drops such as cyclopentolate 1% to reduce painful ciliary muscle spasms [ 1 ].
- Patients should avoid wearing contact lenses until healing is complete and the eye doctor confirms it's safe to resume wear.
- Most corneal abrasions heal within 24-72 hours with proper treatment [ 1 ].
- During healing, patients should avoid rubbing the eye and may need to wear an eye patch for comfort in cases of significant light sensitivity.
- If symptoms worsen (increased pain, discharge, vision changes), immediate medical attention is necessary as this could indicate infection or complications [ 1 ].
Prevention of Infection
- Prophylactic topical antibiotics following corneal abrasion has been shown to prevent ulceration when treatment is started within 24 hours of the abrasion [ 1 ].
- In patients with contact-lens associated abrasion, patching the eye or using a therapeutic contact lens is not advised due to concerns for increased risk of secondary bacterial keratitis [ 1 ].
From the FDA Drug Label
All topical nonsteroidal anti-inflammatory drugs (NSAIDs) may slow or delay healing. In some susceptible patients, continued use of topical NSAIDs may result in epithelial breakdown, corneal thinning, corneal erosion, corneal ulceration or corneal perforation. Patients with evidence of corneal epithelial breakdown should immediately discontinue use of topical NSAIDs and should be closely monitored for corneal health
- Corneal abrasion may be exacerbated by the use of topical NSAIDs, such as ketorolac, as they may slow or delay healing.
- Patients with corneal epithelial breakdown should discontinue use of topical NSAIDs and be closely monitored for corneal health 2.
From the Research
Definition and Symptoms of Corneal Abrasion
- Corneal abrasions result from cutting, scratching, or abrading the thin, protective, clear coat of the exposed anterior portion of the ocular epithelium 3.
- Symptoms of corneal abrasions include pain, tearing, photophobia, foreign body sensation, and a gritty feeling, which can be worsened by exposure to light, blinking, and rubbing the injured surface against the inside of the eyelid 3.
Diagnosis of Corneal Abrasion
- The diagnosis of corneal abrasions can be confirmed by visualizing the cornea under cobalt-blue filtered light after the application of fluorescein 3, 4.
Treatment of Corneal Abrasion
- Initial treatment should be symptomatic, consisting of foreign body removal and analgesia with topical nonsteroidal anti-inflammatory drugs or oral analgesics; topical antibiotics also may be used 3, 4.
- Eye patching is not recommended because it does not improve pain and has the potential to delay healing 3, 5.
- Topical mydriatics and cycloplegics are not beneficial for uncomplicated corneal abrasions 3, 4.
- Antibiotic prophylaxis may be used to prevent bacterial superinfection, but the current evidence is insufficient to support any antibiotic regimen being superior to another 6.
Prevention of Corneal Abrasion
- Corneal abrasions can be avoided through the use of protective eyewear 3.
Management and Follow-up
- Follow-up may not be necessary for patients with small (4 mm or less), uncomplicated abrasions; normal vision; and resolving symptoms, but all other patients should be reevaluated in 24 hours 4.
- Referral is indicated for any patient with symptoms that do not improve or that worsen, a corneal infiltrate or ulcer, significant vision loss, or a penetrating eye injury 4, 7.