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Corneal superficial injury - Management
How should I manage a superficial corneal injury that is not referred?

  • Remove the foreign body if present (and this is appropriate), see Removing a corneal foreign body.
  • Offer or advise analgesia for pain relief.
    • Paracetamol or ibuprofen is recommended first-line.
    • Consider offering a one off dose of a cycloplegic (e.g. cyclopentolate 0.5%) if available.
  • To prevent secondary infection prescribe:
    • Topical chloramphenicol first-line, four times a day, for 7 days.
    • Consider prescribing fusidic acid, twice a day (7 days), as an alternative if:
      • Treatment four times a day is impractical (e.g. children or elderly people).
      • The person is pregnant.
      • There is a personal or family history of blood dyscrasias, such as aplastic anaemia.
      • The person is intolerant of chloramphenicol.
  • Advise the person not to wear contact lenses until the corneal abrasion has completely healed and, where possible, for 24 hours after finishing treatment with topical antibiotics.
Basis for recommendation
  • Topical antibiotics:
    • CKS found no published evidence that antibiotic eye drops or ointment are effective for preventing infection after a corneal injury. However, expert consensus is that they should be used to prevent secondary infection which is a rare but devastating consequence of corneal injury [Khaw et al, 2004b].
    • Chloramphenicol is recommended first-line and fusidic acid is an alternative. For a more detailed discussion, see the CKS topic on Conjunctivitis - infective.
  • Topical cycloplegics:
    • Cycloplegics are claimed to reduce ocular pain and inflammation by alleviating ciliary spasm. There are no controlled studies to support this hypothesis [Sabri et al, 1998; Carley and Carley, 2001]. However some experts recommend a one off dose to reduce headache from ciliary muscle spasm.
  • Removal of contact lenses:
    • Contact lenses must not be worn during treatment because some preservatives, particularly benzalkonium chloride, accumulate in contact lenses and cause irritation.

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