Corneal Abrasions Empiric Therapy

Prophylactic antibiotics have been shown to reduce the risk of secondary infection in the setting of corneal abrasions. ^[1] Antibiotic drops, ointment, or a combination of both can be used. Ointment offers better barrier protection and more lubrication, but can blur the vision temporarily. Antibiotic ointments are considered first-line therapy for corneal abrasions. ^{[2, 3]}

Loose or denuded epithelium should be debrided with either a cotton-tipped applicator soaked in topical anesthetic or a jeweler’s forceps, as the loose epithelium can impede healing.

Non–contact lens wearers

See the list below:

• Antibiotic ointment ( erythromycin ophthalmic, sulfacetamide ophthalmic, neomycin/polymyxin B/bacitracin zinc ophthalmic) applied QID to affected eye(s) for 3-5 days or
• Polymyxin-trimethoprim ophthalmic solution 1-2 drops instilled into affected eye(s) QID for 3-5 days or
• Fluoroquinolone ophthalmic solution ( ciprofloxacin 0.3% ophthalmic, ofloxacin 0.3% ophthalmic, moxifloxacin 0.5% ophthalmic, levofloxacin 0.5% ophthalmic, gatifloxacin 0.3% ophthalmic, besifloxacin 0.6% ophthalmic)  1-2 drops instilled into affected eye(s) QID for 3-5 days or
• Fluoroquinolone ophthalmic solution (see above) QID and antibiotic ointment (see above) QHS for 3-5 days

Note: If the abrasion is secondary to a fingernail or vegetable matter, a fluoroquinolone antibiotic should be included in the treatment regimen.

Contact lens wearers

Contact lens wear should be avoided until the corneal abrasion is healed and the antibiotic course is completed. The patient may resume contact lens wear if the eye feels normal a week after the antibiotic course has been completed. If the lens is implicated, it should be discarded.

• Fluoroquinolone ophthalmic solution ( ciprofloxacin 0.3% ophthalmic, ofloxacin 0.3% ophthalmic, moxifloxacin 0.5% ophthalmic, levofloxacin 0.5% ophthalmic, gatifloxacin 0.3% ophthalmic, besifloxacin 0.6% ophthalmic) 1-2 drops instilled into affected eye(s) q2h while awake for 2 days, then q4-8h for 5 days or
• Fluoroquinolone ophthalmic solution (see above) q2h while awake and antibiotic ointment (see above) QHS for 2 days, then the fluoroquinolone can be reduced to q4-8h and the antibiotic ointment continued for 5 more days. 

Topical analgesics

Topical anesthetic agents should not be used beyond the ophthalmic examination. Although patients may request anesthetics, prolonged use of anesthetics can lead to reduced corneal sensation and immune function, leading to sight-threatening complications. ^[4]

Topical nonsteroidal anti-inflammatory drugs (NSAIDs) may be useful in reducing pain from corneal abrasions. Diclofenac ophthalmic or ketorolac ophthalmic solution 1 drop instilled into affected eye(s) QID for ≤2 weeks.

Cycloplegia can also help with pain, especially if there is a component of traumatic iritis. Short-acting agents such as cyclopentolate hydrochloride 0.5% or 1% 1 drop instilled into affected eye(s) TID for ≤2 weeks can be used.

Special considerations

Patching the eye is rarely needed and should not be performed in patients at high risk of infection, such as those who wear contact lenses and those with trauma caused by vegetable matter.

Patching can increase corneal temperature and therefore increase the risk of secondary microbial keratitis after abrasion. It also reduces oxygenation, which can slow reepithelialization. A Cochrane metareview found that patients with a small injury (< 10 mm) without a patch healed faster than with a patch. ^[5]

A bandage contact lens may be a good alternative. It permits vision and oxygenation, while promoting corneal epithelialization and decreasing pain and can be used for several days without complications. ^[6] It should not be used in patients who wear contact lenses and those with trauma caused by vegetable matter. It requires mandatory follow-up with an eye care professional.

Abrasions resulting from vegetable matter are at high risk for fungal ulcer.

Abrasions resulting from contact lens wear should be monitored for Pseudomonas infection and amebic keratitis.

Patients who wear contact lenses should be checked in 24 hours to rule out corneal infiltrates or ulcers.