From the Guidelines
For corneal abrasions, broad-spectrum topical antibiotic prophylaxis with a quinolone preparation, such as moxifloxacin or levofloxacin, is recommended, used four times daily 1. The choice of antibiotic should be guided by local knowledge of antimicrobial resistance patterns, which vary widely in different countries. In the context of corneal abrasions, it is essential to prevent secondary bacterial infection while the corneal epithelium heals. Some key points to consider when treating corneal abrasions include:
- The use of broad-spectrum topical antibiotic therapy, according to local protocols, may be modified by microbial sensitivity results when these become available 1.
- Culture-guided treatment is mandatory for suspected corneal infection, which may manifest as corneal stromal loss in the absence of an infiltrate 1.
- Topical corticosteroid drops, supervised by an ophthalmologist, may reduce ocular surface damage in the acute phase, but can mask the signs of corneal infection 1. It is crucial to start treatment immediately after diagnosis and continue until the abrasion has fully healed, with patients advised to avoid wearing contact lenses during treatment and until cleared by their eye care provider. Pain management with oral analgesics and possibly cycloplegic drops like cyclopentolate 1% (to reduce ciliary spasm) may be necessary adjuncts to antibiotic therapy. If symptoms worsen or don't improve within 48 hours, patients should seek immediate follow-up care as this could indicate complications or infection.
From the FDA Drug Label
2 DOSAGE AND ADMINISTRATION
• Day 1: Instill one drop every two hours in the affected eye(s) while awake, up to 8 times. • Day 2 through Day 7: Instill one drop two to four times daily in the affected eye(s) while awake.
For corneal abrasion treatment with gatifloxacin (OPHTH) antibiotic drops, the recommended dosage is:
- Day 1: Instill one drop every two hours in the affected eye(s) while awake, up to 8 times.
- Day 2 through Day 7: Instill one drop two to four times daily in the affected eye(s) while awake 2.
From the Research
Corneal Abrasion Antibiotic Drops
- The use of antibiotic drops for corneal abrasions is a common practice, but the evidence for their effectiveness is limited 3.
- A study comparing chloramphenicol ocular ointment with fusidic acid ocular gels found no significant difference in the rate of healing or infection 3.
- Another study found that a three-day course of chloramphenicol-clotrimazole or chloramphenicol-placebo ocular ointment resulted in similar rates of healing and complication 3.
Dosage and Administration
- The dosage and administration of antibiotic drops for corneal abrasions vary depending on the specific medication and formulation 3, 4.
- A study comparing moxifloxacin 0.5% with a combination of fortified cefazolin sodium 5% and tobramycin sulfate 1.3% found that moxifloxacin was equivalent to the combination therapy in treating moderate bacterial corneal ulcers 5.
- The penetration and pharmacokinetics of topical gatifloxacin 0.3% and moxifloxacin 0.5% ophthalmic solutions were compared in a study, which found that moxifloxacin achieved greater corneal and aqueous penetration 4.
Treatment Options
- Topical nonsteroidal anti-inflammatory drugs (NSAIDs) and oral analgesics may be used to manage symptoms of corneal abrasions 6, 7.
- Eye patching is not recommended as it may hinder healing 6, 7.
- The use of topical antibiotics may be considered, but the evidence for their effectiveness is limited and more research is needed to determine the best treatment options 3.