Dr Kola Tytler MBBS CertHE MBA MRCGPClinical Lead • iatroX
Management of a patient with corneal abrasion presenting with significant pain and photophobia:
- Perform a thorough eye examination including visual acuity assessment and fluorescein staining to confirm the abrasion and exclude foreign bodies or other complications NICE CKS.
- Remove any loose superficial foreign bodies if expertise and equipment are available; use topical anaesthetic (one drop of proxymetacaine 0.5%) to aid removal but avoid repeated doses due to toxicity and delayed healing NICE CKS.
- Advise the patient to avoid touching or rubbing the eye and to avoid contact lens use until healing is complete NICE CKS.
- Provide symptom relief with simple oral analgesics such as paracetamol; topical analgesics and cycloplegics are not recommended as they do not improve healing or pain and may cause adverse effects NICE CKS.
- Recommend ocular lubricants (non-prescription lubricating eye drops or ointment) to alleviate discomfort; eye drops may be preferred during the day and ointments at night NICE CKS.
- Advise wearing sunglasses or staying in low light environments to reduce photophobia and light sensitivity NICE CKS.
- Consider prescribing a broad-spectrum topical antibiotic such as chloramphenicol if there is a risk of infection, especially if the abrasion is contaminated or associated with foreign matter; continue antibiotics until 24 hours after symptoms resolve NICE CKS.
- Do not routinely use eye patches as evidence does not support benefit in healing or pain reduction NICE CKS.
- Arrange follow-up within 24 hours to reassess symptoms and healing; instruct the patient to seek urgent review if symptoms worsen, vision decreases, or signs of infection develop NICE CKS.
- Refer urgently to ophthalmology if there is significant visual acuity reduction, increasing size of abrasion, corneal infiltrate, ulcer, infection, or if the abrasion does not heal within 3–4 days NICE CKS.