Corneal Abrasion Health Article

Treatment

If the corneal abrasion is very small and superficial, then the application of mild antibiotic drops three to four times a day for a few days to a week is sufficient to prevent an infection. At bedtime, an antibiotic ointment, which will remain on the eye longer, may be necessary for deep abrasions. When an infection is present, then specially compounded fortified antibiotics, formulated specifically for the organism that caused the infection, are prescribed topically. For those with very minor abrasions, instillation of non-preserved lubricating drops a few times a day for a few days may be all that is required.

The pain of a corneal abrasion can be treated with drugs such as homatropine which keep the eye in a dilated state and stop the spasm of the iris, a major cause of discomfort for the individual with a corneal abrasion. Nonsteroidal drops, called NSAIDs, may also be prescribed for a few days to relieve the pain. In some instances, oral analgesics may be prescribed, but children under 12 should not be given aspirin. If the area is large and there is no underlying viral infection, then a mild steroid to decrease future scarring and treat an associated iritis may also be needed. Topical anesthetics are never prescribed because they delay and interfere with the healing process.

For many years the standard treatment for a corneal abrasion included patching. Patching can decrease blinking, which was thought to speed the healing process. But patching is as of 2004 no longer done routinely because it decreases the amount of oxygen that gets to the cornea. Patching is never done for contact lens patients, whose eyes are at a greater risk of a Pseudomonas infection, nor when the cause of an abrasion is due to vegetative matter, such as a tree branch. Organisms can thrive in these types of environment. Patching is also not done for patients who are monocular (have one good eye), if the better eye has the abrasion, nor for patients for whom depth perception is important, as this is lost when only one eye is used. Controlled studies have demonstrated that patching a corneal abrasion does not improve healing either in children or adults and that patching of an eye may make walking difficult.

For the contact lens wearer with a corneal abrasion, contact lens wear must be discontinued for at least one week and glasses must be worn. Patients who wear contact lenses are given antibiotics that act on the bacteria that are ubiquitous in the eye of the contact lens wearer. The eye must be evaluated by an eye-care practitioner prior to reinstituting contact lens wear.

For the patient with a large abrasion and without an infection, and who does not wear contact lenses, a bandage contact lens approved for extended overnight wear may be worn. The pressure of the contact lens may comfort the patient, and the antibiotics are absorbed by the contact lens, giving the eye continuous 24 hour protection from a potential bacterial infection.

Treatment of a corneal abrasion with over-the-counter (OTC) drugs advertised to decrease redness should not be used to self treat corneal abrasions. These drugs act by constricting the blood vessels in the eye, decreasing the blood supply to the eye and delaying healing. Also, the preservatives in these drops may irritate the cornea.

Except for a very mild abrasion, the doctor may require daily follow-up examination to ensure that the abrasion is healing. This is especially important if vegetative matter is the cause of the abrasion. Those who have been patched must be re-evaluated within 24 hours to see if the symptoms have improved.