Management of Corneal Abrasion After Tetracaine Application

Essential Therapeutic Regimen

The American Academy of Ophthalmology recommends prescribing preservative-free artificial tears, such as hyaluronate or carmellose, every 2 hours while awake for patients with corneal abrasions 1, 2, 4
Preservative-free formulations are critical, as preserved drops worsen epithelial damage in the setting of corneal defects 4
The American Academy of Ophthalmology specifically recommends topical antibiotics, such as moxifloxacin or ofloxacin, four times daily for corneal abrasions, particularly following trauma, to prevent acute bacterial keratitis 1, 2, 3
Prophylactic antibiotics started within 24 hours of abrasion have been shown to prevent ulceration 3
Continue antibiotics until the epithelial defect heals completely 4

Do not patch the eye, as this increases the risk of secondary bacterial keratitis, especially in contact lens wearers 3
Do not use therapeutic contact lenses in contact lens-associated abrasions due to infection risk 3

Schedule ophthalmologic follow-up within 24-48 hours to assess healing with fluorescein staining 2, 4
Daily ophthalmologic review is necessary during the acute phase for significant abrasions 1, 2
Watch for warning signs of infection: increased pain, purulent discharge, worsening symptoms, or lack of improvement within 48 hours 4

For central location threatening the visual axis, consider topical corticosteroids, such as dexamethasone 0.1% twice daily, after 2-3 days of antibiotic therapy once epithelial healing has begun, but only under ophthalmology supervision 1, 2, 5
For contact lens-related injury, culture the lens and case, as these patients have higher infection risk 3, 6
For vegetable matter or organic material exposure, obtain cultures due to higher risk for fungal infection 6
For large or deep abrasions, consider more frequent antibiotic dosing and closer monitoring 6

For pain control, prescribe oral NSAIDs or acetaminophen rather than topical anesthetics 2