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.
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.
Trimethoprim/polymyxin B ophthalmic (Polytrim Ophthalmic Solution)
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 (Sulfacetamide Ophth, Bleph 10, Bleph 30)
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.
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)
Scopolamine 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.
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 ophthalmic (Alcaine, Ophthaine, Ophthetic)
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.
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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This corneal abrasion appears as a yellow-green area when stained with fluorescein and viewed with a blue light.
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Corneal abrasion.
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Large corneal abrasion.
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Corneal keratitis and staining.
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Corneal foreign body.
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Corneal foreign body after removal.
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Corneal foreign body with cobalt blue lighting showing abrasion.
