Corneal Abrasions From Emedicine + Outpatient Topical Anesthetics for Corneal Abrasions from Emergency Medicine Cases

Corneal abrasions are the most common eye injuries.

This post has links to three great resources with some excerpts from the first two:

  1. Corneal Abrasions from Emedicine
  2. Corneal Abrasions Empiric Therapy from Emedicine
  3. Outpatient Topical Anesthetics for Corneal Abrasions EM Cases Journal Jam Podcast 6 of EM Cases

1. See the article on corneal abrasions for an excellent review. Some excerpts follow:

The prognosis is usually excellent, with full recovery of vision if treatment is prompt; however, untreated corneal abrasions can lead to blinding corneal ulcers.

Some deep abrasions (eg, those involving the corneal stromal layer) in the central visual axis (ie, the central area of the cornea directly over the pupil) heal but leave a scar. In these instances, a permanent loss of visual acuity may occur.

Healing of minor abrasions is expected within 24-48 hours. Extensive or deep abrasions may require a week to heal.

Significant morbidity is uncommon and mostly observed with infectious complications or allergies to medications used for treatment. Patients who are poorly nourished or who have compromised corneas are at particular risk. Close follow-up care is necessary, however, because of the ever-present danger of the abrasion progressing to an ulcer. Essentially all corneal ulcers begin with an abrasion. [Emphasis added]

Corneal abrasions associated with contact lenses can progress to pseudomonal or amebic keratitis and lead to further ocular damage (including perforation or corneal scarring) if not treated promptly.[16] Abrasions involving exposure to vegetable matter are at a high risk for becoming fungal ulcers.

2. Corneal Abrasions Empiric Therapy from Emedicine is an excellent one page review. Some excerpts follow:

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]

[See article form antibiotic recommendations for non-contact lens wearers and for contact lens wearers]

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.

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.

3. Outpatient Topical Anesthetics for Corneal Abrasions EM Cases Journal Jam Podcast 6 [Link is to the podcast and show notes].

Dr. Hellman states:

I’ve been told countless times by ophthalmologists and other colleagues NEVER to prescribe topical anesthetics for corneal abrasion patients, with the reason being largely theoretical. . . .

To discuss the paper “The Safety of Topical Anesthetics in the Treatment of Corneal Abrasions: A Review” by Drs. Swaminathan, Otterness, Milne and Rezaie published in the Journal of Emergency Medicine in 2015, we have EM Cases’ Justin Morgenstern, a Toronto-based EM Doc, EBM enthusiast as well as the brains behind the First10EM blog interview Salim Rezaie, Clinical Assistant Professor of EM and Internal Medicine at University of Texas Health Science Center at San Antonio as well as the Creator & Founder of the R.E.B.E.L. EM blog and REBELCast podcast.

And last but not least Dr. Hellman’s podcast includes invaluable advice:

In this Journal Jam podcast, Dr. Morgenstern and Dr. Rezaie also discuss a simple approach to critically appraising a systematic review article, how to handle consultants who might not be aware of the literature and/or give you a hard time about your decisions and much more…


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