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Corneal superficial injury - Management
What treatments are not recommended?

  • Corneal patches:
    • Evidence indicates that treating simple corneal abrasions with a patch does not improve healing rates on the first day post-injury and does not reduce pain. In addition, the use of patches results in a loss of binocular vision [Turner and Rabiu, 2006].
  • Topical anaesthetics (except as part of the examination):
    • Topical anaesthetics should not be used, except as part of the examination. They abolish the corneal reflex, which increases the risk of further corneal damage. They slow healing and aggravate associated keratitis [Wilson and Last, 2004].
  • Diclofenac eye drops:
    • Diclofenac eye drops are licensed to treat pain after a corneal abrasion [BNF 54, 2007]. There is evidence for the use of nonsteroidal anti-inflammatory drugs (NSAIDs) for pain associated with a corneal abrasion; but insufficient evidence to be certain about the efficacy of topical NSAIDs.
    • In primary care oral analgesia should be adequate to alleviate pain of a corneal abrasion and will usually be initiated first (if required); making the use of topical NSAIDs unlikely. Topical NSAIDs should not be used as a substitute for oral analgesia, a statement which was highlighted by the CKS external review experts. If pain does persist with oral analgesia or has not resolved within 1-2 days, then referral to secondary care is recommended, further limiting the use of topical NSAIDs in a primary care setting.
  • Topical corticosteroids:
    • Topical corticosteroids should not be used. They slow corneal epithelial and stromal healing, increase the risk of infection, and cause serious scarring and visual loss if a dendritic ulcer has been missed [Shields, 2000a].
  • Tetanus immunization (not routinely needed for non-penetrating injuries).

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