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Corneal Abrasion Medication

  • Author: Arun Verma, MD; Chief Editor: Hampton Roy, Sr, MD  more...
 
Updated: Dec 01, 2015
 

Medication Summary

The goals of pharmacotherapy are to reduce morbidity and to prevent complications. Antibiotics may be used to prevent infection. Anticholinergics can reduce pain and photophobia in patients with large corneal abrasions. Topical anesthetics are used for analgesia to facilitate an adequate examination. Analgesics are indicated, as corneal abrasions can cause severe pain.

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Antibiotics

Class Summary

Therapy must be comprehensive and should cover all likely pathogens in the context of the clinical setting.

Ofloxacin ophthalmic (Ocuflox)

 

Ofloxacin is a pyridine carboxylic acid derivative with broad-spectrum bactericidal effect. It inhibits bacterial growth by inhibiting DNA gyrase. It is indicated for superficial ocular infections of conjunctiva or cornea due to susceptible microorganisms.

Polymyxin B/trimethoprim (Polytrim)

 

This combination is used for ocular infection of the cornea or conjunctiva caused by susceptible microorganisms. It is available as a solution (polymyxin/trimethoprim) and as an ointment (polymyxin/bacitracin).

Ciprofloxacin (Ciloxan)

 

Ciprofloxacin has activity against Pseudomonas and Streptococcus species, methicillin-resistant Staphylococcus aureus (MRSA), S epidermidis, and most gram-negative organisms; it has no activity against anaerobes.

Norfloxacin (Noroxin)

 

Norfloxacin has activity against susceptible gram-negative and gram-positive bacteria. Antibiotics in this class inhibit bacterial DNA synthesis and thus growth by inhibiting DNA gyrase.

Erythromycin ophthalmic (E-Mycin, Iloticin)

 

Erythromycin is indicated for infections caused by susceptible strains of microorganisms and for prevention of corneal and conjunctival infections.

Sulfacetamide ophthalmic (Sulfamide, Bleph-10)

 

This agent interferes with bacterial growth by inhibiting bacterial folic acid synthesis by competitively antagonizing para-aminobenzoic acid. It is available in solution, ointment, and lotion form.

Tobramycin ophthalmic (Tobrex, Ak-Tob)

 

Tobramycin is an aminoglycoside that interferes with bacterial protein synthesis by binding to 30S and 50S ribosomal subunits, causing a defective bacterial cell membrane. It is available in solution, ointment, and lotion form.

Gentamicin (Gentak, Garamycin)

 

Gentamicin is an aminoglycoside antibiotic that covers gram-negative bacteria.

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Anticholinergic Agents (Cycloplegics and Mydriatics)

Class Summary

These drugs are used in large abrasions. Specific agents such as cyclopentolate or atropine or even homatropine drops or ointments are useful adjuncts.

Scopolamine (Isopto Hyoscine)

 

Scopalamine blocks action of acetylcholine at parasympathetic sites in smooth muscle, producing pupillary dilation (mydriasis) and paralysis of accommodation (cycloplegia).

Cyclopentolate HCl 1% (Cyclogyl, AK-Pentolate, Cylate)

 

Cyclopentolate is the anticholinergic drug of choice in the treatment of cornea abrasions. It prevents the muscle of ciliary body and sphincter muscle of the iris from responding to cholinergic stimulation, causing mydriasis and cycloplegia. It induces mydriasis in 30-60 min and cycloplegia in 25-75 min; effects last up to 24 h.

Atropine (Isopto, Atropair, Isopto Atropine, Atropine Care)

 

Atropine acts at parasympathetic sites in smooth muscle to block response of sphincter muscle of iris and muscle of ciliary body to acetylcholine, causing mydriasis and cycloplegia. Concurrent phenylephrine (2.5% or 10% solution) may prevent the formation of synechiae by producing wide dilation of the pupil. Atropine induces mydriasis in 10-30 min and cycloplegia in 30-90 min; effects last up to 48 h.

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Topical Anesthetics

Class Summary

Topical anesthetics are used for analgesia to facilitate an adequate examination. These agents should never be prescribed for home use because they can cause secondary keratitis, compromise healing of the epithelial wound, and block protective corneal reflexes and sensation.

Tetracaine (Altacaine, TetraVisc, Tetcaine)

 

Tetracaine is a local anesthetic that blocks initiation and conduction of nerve impulses by decreasing sodium permeability of the neuronal membrane, inhibiting depolarization and blocking impulse conduction. Onset of action is in 1 min; the anesthetic effect lasts up to 15-20 min. This agent stings considerably on application. It is available as a solution and an ointment.

Proparacaine 0.5% (Alcaine, Parcaine)

 

Proparacaine is the least irritating of the topical anesthetics. It prevents initiation and transmission of impulses at the nerve cell membrane by stabilizing it and decreasing ion permeability. Onset of action is in 20 sec; anesthetic effect lasts up to 10-15 min.

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Analgesics

Class Summary

Some ophthalmologists advocate the use of diclofenac (Voltaren) or ketorolac (Acular) drops with a disposable soft contact lens in addition to antibiotic drops. This therapy may be an effective alternative to patching, as it allows the patient to maintain binocular vision during treatment and reduces inflammation. Patients with all but the most minor abrasions usually require a strong oral narcotic analgesic.

Diclofenac (Voltaren)

 

These nonsteroidal anti-inflammatory drugs inhibit prostaglandin synthesis by decreasing cyclooxygenase activity, decreasing formation of prostaglandin precursors.

Ketorolac tromethamine 0.5% (Acular, Acuvail)

 

These nonsteroidal anti-inflammatory drugs inhibit prostaglandin synthesis by decreasing cyclooxygenase activity, decreasing formation of prostaglandin precursors.

Hydrocodone bitartrate and acetaminophen (Vicodin ES, Hycet, Zolvit, Zydone)

 

These drug combinations are used for relief of moderate to severe pain.

Oxycodone and acetaminophen (Percocet, Roxicet, Primlev, Tylox)

 

These drug combinations are used for relief of moderate to severe pain.

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Contributor Information and Disclosures
Author

Arun Verma, MD Senior Consultant, Department of Ophthalmology, Dr Daljit Singh Eye Hospital, India

Disclosure: Nothing to disclose.

Coauthor(s)

Feras H Khan, MD Clinical Assistant Professor, Department of Emergency Medicine, University of Maryland School of Medicine; Attending Physician, Department of Emergency Medicine, Laurel Regional Hospital, University of Maryland Emergency Medicine Network Physicians; Attending Physician, Intensivist, Department of Critical Care Medicine, Mercy Medical Center

Disclosure: Nothing to disclose.

Chief Editor

Hampton Roy, Sr, MD Associate Clinical Professor, Department of Ophthalmology, University of Arkansas for Medical Sciences

Hampton Roy, Sr, MD is a member of the following medical societies: American Academy of Ophthalmology, American College of Surgeons, Pan-American Association of Ophthalmology

Disclosure: Nothing to disclose.

Acknowledgements

Kilbourn Gordon III, MD, FACEP Urgent Care Physician

Kilbourn Gordon III, MD, FACEP is a member of the following medical societies: American Academy of Ophthalmology and Wilderness Medical Society

Disclosure: Nothing to disclose.

Christopher J Rapuano, MD Professor, Department of Ophthalmology, Jefferson Medical College of Thomas Jefferson University; Director of the Cornea Service, Co-Director of Refractive Surgery Department, Wills Eye Institute

Christopher J Rapuano, MD is a member of the following medical societies: American Academy of Ophthalmology, American Society of Cataract and Refractive Surgery, Contact Lens Association of Ophthalmologists, Cornea Society, Eye Bank Association of America, International Society of Refractive Surgery, and Pan-American Association of Ophthalmology

Disclosure: Allergan Honoraria Speaking and teaching; Allergan Consulting fee Consulting; Alcon Honoraria Speaking and teaching; Inspire Honoraria Speaking and teaching; RPS Ownership interest Other; Vistakon Honoraria Speaking and teaching; EyeGate Pharma Consulting; Inspire Consulting fee Consulting; Bausch & Lomb Honoraria Speaking and teaching; Bausch & Lomb Consulting fee Consulting

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

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This corneal abrasion appears as a yellow-green area when stained with fluorescein and viewed with a blue light.
Corneal abrasion.
Corneal abrasion.
Corneal keratitis and staining.
Corneal foreign body.
Corneal foreign body after removal.
Corneal foreign body with cobalt blue lighting showing abrasion.
 
 
 
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