Treatment algorithm

Please note that formulations/routes and doses may differ between drug names and brands, drug formularies, or locations. Treatment recommendations are specific to patient groups: see disclaimer

ACUTE

superficial injuries without a foreign body

1st line – observation plus topical antibiotic

Back
ACUTE
|
superficial injuries without a foreign body
|
exposure to ultraviolet light
1st line – 

observation plus topical antibiotic

Following exposure to ultraviolet light, healing usually occurs within 24 hours with conservative treatment (i.e., observation, preservative-free artificial tears, topical antibiotic ointment).

Primary options

erythromycin ophthalmic: (0.5% ointment) children and adults: apply to the affected eye(s) up to six times daily

1st line – immediate irrigation

Back
ACUTE
|
superficial injuries without a foreign body
|
chemical splashes
1st line – 

immediate irrigation

Should be treated with immediate eye irrigation, using isotonic saline or sterile water.[33]​[46]​​​ Irrigation for known chemical injury should proceed for at least 15 minutes before examination is attempted. To measure pH, cease irrigation, wait for 1 minute, then apply universal indicator (pH) paper to the fornix. Continue irrigation and pH checking in this way until the pH normalises (range: 7.0 to 7.5).[33]

Irrigation may take several hours. Obtain an ophthalmology consultation after irrigation.

Consider – topical antibiotic

Back
ACUTE
|
superficial injuries without a foreign body
|
chemical splashes
Consider – 

topical antibiotic

Additional treatment recommended for SOME patients in selected patient group

Topical antibiotic ointments and drops should be used until the epithelium is healed. Ointments are preferred to drops, as they function as lubricants, but they cause a blurring effect (thus, consider a combination of eye drops for the day and ointments at night). Continue therapy for 24 hours after the patient has become symptom-free.

Primary options

erythromycin ophthalmic: (0.5% ointment) children and adults: apply to the affected eye(s) up to six times daily

OR

ciprofloxacin ophthalmic: (0.3% solution) children and adults: 2 drops into the affected eye(s) every 15 minutes for 6 hours, followed by 2 drops every 30 minutes for 18 hours, then 2 drops every hour for 1 day, then 2 drops every 4 hours thereafter

OR

ofloxacin ophthalmic: (0.3% solution) children ≥1 year of age and adults: 1-2 drops into the affected eye(s) every 30 minutes while awake and every 4-6 hours during sleep hours for 2 days, followed by 1-2 drops every hour while awake for 4-6 days, then 1-2 drops four times daily thereafter

Consider – topical corticosteroid

Back
ACUTE
|
superficial injuries without a foreign body
|
chemical splashes
Consider – 

topical corticosteroid

Additional treatment recommended for SOME patients in selected patient group

Topical corticosteroids (e.g., prednisolone) may be used for 5-7 days.

Primary options

prednisolone ophthalmic: (1% suspension) children and adults: 1-2 drops into the affected eye(s) two to four times daily

1st line – supportive care

Back
ACUTE
|
superficial injuries without a foreign body
|
black eye (ecchymosis)
1st line – 

supportive care

Treatment includes ice, analgesics (aspirin should be avoided because it can predispose to bleeding), rest, and possible protection of the injured area with an eye shield.

Associated ocular injuries should be ruled out by an experienced physician.

Primary options

paracetamol: children: 10-15 mg/kg orally every 4-6 hours when required, maximum 75 mg/kg/day; adults: 500-1000 mg orally every 4-6 hours when required, maximum 4000 mg/day

1st line – topical antibiotic

Back
ACUTE
|
superficial injuries without a foreign body
|
minor abrasions (non-contact lens wearers)
1st line – 

topical antibiotic

For minor abrasions (i.e., small and superficial) or other irritations that affect only the surface of the eye (i.e., the conjunctiva or cornea) and when no foreign bodies are present, short-term topical antibiotic treatment is usually sufficient to ease discomfort while healing. Topical antibiotics may also be considered if there are concerns for infection. It is unclear, however, whether antibiotic prophylaxis can prevent eye infections.[47]​ 

Topical antibiotic ointment or antibiotic drops should be used for 5-7 days. Ointments are preferred to drops, as they function as lubricants that ease discomfort. They also cause a blurring effect (thus, consider a combination of eye drops for the day and ointments at night). Continue therapy for 24 hours after the patient has become symptom-free.

Eye patching for simple abrasions offers no clear benefits for healing and has the disadvantage of causing monocular vision. [ Cochrane Clinical Answers logo ] ​ Avoid eye patches if you suspect infection.

Primary options

erythromycin ophthalmic: (0.5% ointment) children and adults: apply to the affected eye(s) up to six times daily

OR

ciprofloxacin ophthalmic: (0.3% solution) children and adults: 2 drops into the affected eye(s) every 15 minutes for 6 hours, followed by 2 drops every 30 minutes for 18 hours, then 2 drops every hour for 1 day, then 2 drops every 4 hours thereafter

OR

ofloxacin ophthalmic: (0.3% solution) children ≥1 year of age and adults: 1-2 drops into the affected eye(s) every 30 minutes while awake and every 4-6 hours during sleep hours for 2 days, followed by 1-2 drops every hour while awake for 4-6 days, then 1-2 drops four times daily thereafter

1st line – topical antibiotic

Back
ACUTE
|
superficial injuries without a foreign body
|
minor abrasions (contact lens wearers)
1st line – 

topical antibiotic

Patients may require a topical antibiotic to prevent infection.[47]​ Ointments are preferred to drops, as they function as lubricants that ease discomfort. They also cause a blurring effect (thus, consider a combination of eye drops for the day and ointments at night). Continue therapy for 24 hours after the patient has become symptom-free.

Contact lens-related abrasions have a higher rate of Pseudomonas infection, requiring treatment with topical ophthalmic fluoroquinolones (e.g., ciprofloxacin, ofloxacin) or aminoglycosides (e.g., gentamicin, tobramycin). This group should receive ophthalmological follow-up within 24-48 hours.

Advise the patient to stop wearing contact lenses temporarily. Contact lens use may be restarted once approved by an ophthalmologist or, for small defects, once the patient has been symptom-free for 24 hours.

Primary options

ciprofloxacin ophthalmic: (0.3% solution) children and adults: 2 drops into the affected eye(s) every 15 minutes for 6 hours, followed by 2 drops every 30 minutes for 18 hours, then 2 drops every hour for 1 day, then 2 drops every 4 hours thereafter

OR

ofloxacin ophthalmic: (0.3% solution) children ≥1 year of age and adults: 1-2 drops into the affected eye(s) every 30 minutes while awake and every 4-6 hours during sleep hours for 2 days, followed by 1-2 drops every hour while awake for 4-6 days, then 1-2 drops four times daily thereafter

OR

gentamicin ophthalmic: (0.3% solution) children ≥1 month of age and adults: 1-2 drops into the affected eye(s) every 4 hours (up to 2 drops every hour for severe infections); (0.3% ointment) children ≥1 month of age and adults: apply to the affected eye(s) two to three times daily

OR

tobramycin ophthalmic: (0.3% solution) children ≥2 months of age and adults: 1-2 drops into the affected eye(s) every 4 hours (up to 2 drops every hour for severe infections)

1st line – suturing

Back
ACUTE
|
superficial injuries without a foreign body
|
eyelid lacerations
1st line – 

suturing

The wound should be cleaned with minimal debridement and simple lacerations sutured.

Patients should be referred to a specialist when the margin of the eyelid is involved, the medial part of the eyelid is lacerated (which could signify involvement of the tear duct), or fat is prolapsed.

hyphaema

1st line – supportive care

Back
ACUTE
|
hyphaema
1st line – 

supportive care

Place a protective eye shield over the traumatised eye, restrict activity, and advise patients to elevate the head of their bed to allow blood to settle.​ Most hyphaemas resolve spontaneously within 2-6 days of injury. Offer frequent follow-up examinations to monitor for elevated intra-ocular pressure (IOP) or re-bleeding, and advise patients to avoid aspirin or other non-steroidal anti-inflammatory drugs.

Consider – topical cycloplegic

Back
ACUTE
|
hyphaema
Consider – 

topical cycloplegic

Additional treatment recommended for SOME patients in selected patient group

Dilation of the eye may be achieved with cycloplegic eye drops, which will reduce discomfort.[49]

Primary options

cyclopentolate ophthalmic: (0.5%, 1%, 2% solution) children and adults: 1-2 drops into the affected eye(s) once or twice daily

OR

atropine ophthalmic: (1% solution) children: children ≥3 months of age and adults: 1 drop into the affected eye(s) once or twice daily

Consider – topical corticosteroid

Back
ACUTE
|
hyphaema
Consider – 

topical corticosteroid

Additional treatment recommended for SOME patients in selected patient group

Topical corticosteroids (e.g., prednisolone) treat eye inflammation, which can help reduce discomfort.

Primary options

prednisolone ophthalmic: (1% suspension) children and adults: 1-2 drops into the affected eye(s) two to four times daily

Consider – anti-emetic

Back
ACUTE
|
hyphaema
Consider – 

anti-emetic

Additional treatment recommended for SOME patients in selected patient group

Patients with nausea or vomiting require anti-emetics (e.g., prochlorperazine) to prevent sudden increase in intra-ocular pressure caused by emesis.

Nausea can be a sign of increased intra-ocular pressure.

Primary options

prochlorperazine: children ≥2 years of age and body weight 9-14 kg: 2.5 mg orally every 12-24 hours when required, maximum 7.5 mg/day; children ≥2 years of age and body weight 14-18 kg: 2.5 mg orally every 8-12 hours when required, maximum 10 mg/day; children ≥2 years of age and body weight 18-39 kg: 2.5 mg orally every 8 hours or 5 mg every 12 hours when required, maximum 15 mg/day; children ≥2 years of age and body weight >39 kg: 5 mg orally every 6-8 hours when required, maximum 20 mg/day; adults: 5-10 mg orally every 6-8 hours when required, maximum 40 mg/day

Consider – antifibrinolytic

Back
ACUTE
|
hyphaema
Consider – 

antifibrinolytic

Additional treatment recommended for SOME patients in selected patient group

Antifibronlytic agents (e.g., aminocaproic acid, tranexamic acid) may reduce and stabilise blood clots by preventing fibrinolysis.[48][50]​​​​​​​ [ Cochrane Clinical Answers logo ] ​​ However, these agents have significant adverse effects (e.g., increased risk of thrombosis, nausea, abdominal pain) and are not used routinely to treat hyphaema. One systematic review found no good evidence to support the use of antifibrinolytic agents in the management of traumatic hyphaema (other than reducing secondary haemorrhage rate).[48]

Primary options

aminocaproic acid: consult specialist for guidance on dose

OR

tranexamic acid: consult specialist for guidance on dose

Consider – surgery

Back
ACUTE
|
hyphaema
Consider – 

surgery

Additional treatment recommended for SOME patients in selected patient group

Surgical treatment with an anterior chamber washout is indicated when the hyphaema is complicated by corneal blood staining or when a view is necessary to treat retinal pathology.[51]

Consider – IOP-lowering therapy

Back
ACUTE
|
hyphaema
|
with raised intra-ocular pressure (IOP)
Consider – 

IOP-lowering therapy

Additional treatment recommended for SOME patients in selected patient group

Elevated intra-ocular pressure (IOP) is present in 40% of hyphaemas at presentation.[23]​ If the intra-ocular pressure is elevated, topical IOP-lowering medications such as beta-blockers and alpha agonists are first-line agents. If topical management fails, systemic carbonic anhydrase inhibitors and hyperosmotic agents may be required.

See Angle-closure glaucoma (Management approach) for further detail.

Consider – surgery

Back
ACUTE
|
hyphaema
|
with raised intra-ocular pressure (IOP)
Consider – 

surgery

Additional treatment recommended for SOME patients in selected patient group

Consider surgical treatment with an anterior chamber washout when the hyphaema is complicated by persistently elevated IOP despite optimal medical management.

In patients with sickle-cell trait or disease, perform surgical intervention if the IOP exceeds 24 units for more than 24 hours, given the risk of optic nerve damage.[51]

Consider – treatment of underlying condition

Back
ACUTE
|
hyphaema
|
with bleeding tendency
Consider – 

treatment of underlying condition

Additional treatment recommended for SOME patients in selected patient group

Patients with a bleeding tendency (e.g., haemophilia, thrombocytopenia or those on anticoagulants should receive appropriate treatment to restore clotting ability.

corneal abrasion

1st line – foreign body removal

Back
ACUTE
|
corneal abrasion
1st line – 

foreign body removal

Initial treatment involves the removal of any retained foreign body (where appropriate).​ Rule out eyelid foreign bodies by double eversion of the eyelids. If penetration in the anterior chamber is identified or suspected, remove the foreign body in the operating room.

Remove any retained body using a saline flush, fine-tipped forceps or a blunt spatula, or a sterile saline-wetted cotton bud or disposable hypodermic needle.[52][53]​​​ Avoid aggressive attempts to remove deeply embedded foreign bodies.

Remove metal and organic matter without delay; remove associated corneal rust rings at follow-up within 24-48 hours.

Contact lenses should not be worn while the eye recovers. Contact lens use may be restarted once approved by an ophthalmologist or, for small defects, once the patient has been symptom-free for 24 hours.

Consider – topical anaesthetic

Back
ACUTE
|
corneal abrasion
Consider – 

topical anaesthetic

Additional treatment recommended for SOME patients in selected patient group

Consider topical ophthalmic anaesthesia to provide initial symptom relief and aid initial examination.[33]

One Cochrane review concluded that it is uncertain whether topical anaesthetics effectively treat pain associated with corneal abrasions or improve corneal healing.[32]​ Repeated use of topical anaesthetics is probably toxic to the corneal epithelium and may impair healing (e.g., risks corneal melting, ring infiltrates, and infection).[55][56]

Patients should not receive topical anaesthetics for use at home.[56]​​ 

Primary options

proxymetacaine ophthalmic: (0.5% solution) children and adults: 1-2 drops into the affected eye(s) before procedure

OR

tetracaine ophthalmic: (0.5% solution) children ≥2 years of age and adults: 1 drop into the affected eye(s) before procedure

Consider – topical cycloplegic

Back
ACUTE
|
corneal abrasion
Consider – 

topical cycloplegic

Additional treatment recommended for SOME patients in selected patient group

Cycloplegics can reduce pain and photophobia caused by ciliary spasm, but they lack convincing evidence for their use. Nevertheless, they may have a role in patients who experience significant pain from large defects, when treatment should continue until the eye has healed or the symptoms have disappeared.

Primary options

cyclopentolate ophthalmic: (0.5%, 1%, 2% solution) children and adults: 1-2 drops into the affected eye(s) once or twice daily

OR

atropine ophthalmic: (1% solution) children: children ≥3 months of age and adults: 1 drop into the affected eye(s) once or twice daily

Consider – analgesia

Back
ACUTE
|
corneal abrasion
Consider – 

analgesia

Additional treatment recommended for SOME patients in selected patient group

Analgesics may be required for pain relief, especially in the first 24 hours. Non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen are preferred in patients with tissue swelling, reserving paracetamol for use when NSAIDs are contraindicated.

Topical ophthalmic NSAIDs can cause melts (peripheral ulcerative keratitis) in the setting of epithelial defects and offer no clear benefits over oral analgesia.[54]

Primary options

ibuprofen: children: 5-10 mg/kg orally every 6-8 hours when required, maximum 30 mg/kg/day; adults: 300-400 mg orally every 6-8 hours when required, maximum 2400 mg/day

OR

paracetamol: children: 10-15 mg/kg orally every 4-6 hours when required, maximum 75 mg/kg/day; adults: 500-1000 mg orally every 4-6 hours when required, maximum 4000 mg/day

Plus – topical antibiotic

Back
ACUTE
|
corneal abrasion
|
non-contact lens wearers
Plus – 

topical antibiotic

Treatment recommended for ALL patients in selected patient group

Patients are typically treated with a topical antibiotic to prevent infection and provide symptom relief.[47]​ Ointments are preferred to drops, as they function as lubricants, but they cause a blurring effect (thus, consider a combination of eye drops for the day and ointments at night).

Continue therapy for 24 hours after the patient has become symptom-free. The preferred antibiotics for traumatic or foreign body-related infection are erythromycin, ciprofloxacin, and ofloxacin.

Primary options

erythromycin ophthalmic: (0.5% ointment) children and adults: apply to the affected eye(s) up to six times daily

OR

ciprofloxacin ophthalmic: (0.3% solution) children and adults: 2 drops into the affected eye(s) every 15 minutes for 6 hours, followed by 2 drops every 30 minutes for 18 hours, then 2 drops every hour for 1 day, then 2 drops every 4 hours thereafter

OR

ofloxacin ophthalmic: (0.3% solution) children ≥1 year of age and adults: 1-2 drops into the affected eye(s) every 30 minutes while awake and every 4-6 hours during sleep hours for 2 days, followed by 1-2 drops every hour while awake for 4-6 days, then 1-2 drops four times daily thereafter

Plus – topical antibiotic

Back
ACUTE
|
corneal abrasion
|
contact lens wearers
Plus – 

topical antibiotic

Treatment recommended for ALL patients in selected patient group

Contact lens-related abrasions have a higher rate of Pseudomonas infection, requiring treatment with topical fluoroquinolones (e.g., ciprofloxacin, ofloxacin) or aminoglycosides (e.g., gentamicin, tobramycin), especially if there is substantial epithelial loss or contamination.

Treatment also provides symptom relief.[47]​ Ointments are preferred to drops, as they function as lubricants, but they cause a blurring effect (thus, consider a combination of eye drops for the day and ointments at night). Continue therapy for 24 hours after the patient has become symptom-free.

Advise the patient to stop wearing contact lenses temporarily. Contact lens use may be restarted once approved by an ophthalmologist or, for small defects, once the patient has been symptom-free for 24 hours.

This group should receive ophthalmological follow-up within 24-48 hours.

Primary options

ciprofloxacin ophthalmic: (0.3% solution) children and adults: 2 drops into the affected eye(s) every 15 minutes for 6 hours, followed by 2 drops every 30 minutes for 18 hours, then 2 drops every hour for 1 day, then 2 drops every 4 hours thereafter

OR

ofloxacin ophthalmic: (0.3% solution) children ≥1 year of age and adults: 1-2 drops into the affected eye(s) every 30 minutes while awake and every 4-6 hours during sleep hours for 2 days, followed by 1-2 drops every hour while awake for 4-6 days, then 1-2 drops four times daily thereafter

OR

gentamicin ophthalmic: (0.3% solution) children ≥1 month of age and adults: 1-2 drops into the affected eye(s) every 4 hours (up to 2 drops every hour for severe infections); (0.3% ointment) children ≥1 month of age and adults: apply to the affected eye(s) two to three times daily

OR

tobramycin ophthalmic: (0.3% solution) children ≥2 months of age and adults: 1-2 drops into the affected eye(s) every 4 hours (up to 2 drops every hour for severe infections)

open globe injury

1st line – ophthalmology referral

Back
ACUTE
|
open globe injury
1st line – 

ophthalmology referral

As soon as the diagnosis of an open globe injury is made, the examination should be stopped, the eye covered with a protective shield, and the patient referred to an experienced eye surgeon.​ Patients with these injuries will require hospitalisation.

Plus – systemic antibiotic therapy

Back
ACUTE
|
open globe injury
Plus – 

systemic antibiotic therapy

Treatment recommended for ALL patients in selected patient group

Traumatic endophthalmitis may be associated with poor outcomes. Therefore, all patients with an open globe injury should receive systemic antibiotics (e.g., a fluoroquinolone such as moxifloxacin).

An intact conjunctiva with suspected posterior rupture may not require systemic antibiotics (e.g., if low eye pressure and haemorrhagic chemosis).

Consult local guidance for choice of antibiotics.

Plus – surgery

Back
ACUTE
|
open globe injury
Plus – 

surgery

Treatment recommended for ALL patients in selected patient group

For those injuries that require surgery, prompt repair by an ophthalmologist (within 24 hours) is required to restore the integrity of the eye and prevent infection.

Pars plana vitrectomy is indicated in cases where there is an intra-ocular foreign body injury in the vitreous or a traumatic retinal detachment.[60]

Lensectomy may be required for traumatic cataract, or subluxated or dislocated lens.

Consider – tetanus prophylaxis

Back
ACUTE
|
open globe injury
Consider – 

tetanus prophylaxis

Additional treatment recommended for SOME patients in selected patient group

Tetanus prophylaxis should be established and, if required, a booster injection should be given.​[58]

Consider – analgesia

Back
ACUTE
|
open globe injury
Consider – 

analgesia

Additional treatment recommended for SOME patients in selected patient group

These patients will require pain control medication.

Assess pain and prescribe appropriate analgesia. Simple analgesics (e.g., ibuprofen, paracetamol) should be tried first. Opioids (e.g., morphine) may be required for severe pain.

Primary options

ibuprofen: children: 5-10 mg/kg orally every 6-8 hours when required, maximum 30 mg/kg/day; adults: 300-400 mg orally every 6-8 hours when required, maximum 2400 mg/day

OR

paracetamol: children: 10-15 mg/kg orally every 4-6 hours when required, maximum 75 mg/kg/day; adults: 500-1000 mg orally every 4-6 hours when required, maximum 4000 mg/day

Secondary options

morphine sulfate: children: consult specialist for guidance on dose; adults: 2.5 to 10 mg intravenously/subcutaneously every 2-6 hours when required, or 10-30 mg orally (immediate-release) every 4 hours when required, adjust dose according to response

Consider – anti-emetic

Back
ACUTE
|
open globe injury
Consider – 

anti-emetic

Additional treatment recommended for SOME patients in selected patient group

Patients with nausea or vomiting require anti-emetics (e.g., prochlorperazine) to prevent sudden increase in intra-ocular pressure caused by emesis.

Nausea can also be a sign of increased intra-ocular pressure.

Primary options

prochlorperazine: children ≥2 years of age and body weight 9-14 kg: 2.5 mg orally every 12-24 hours when required, maximum 7.5 mg/day; children ≥2 years of age and body weight 14-18 kg: 2.5 mg orally every 8-12 hours when required, maximum 10 mg/day; children ≥2 years of age and body weight 18-39 kg: 2.5 mg orally every 8 hours or 5 mg every 12 hours when required, maximum 15 mg/day; children ≥2 years of age and body weight >39 kg: 5 mg orally every 6-8 hours when required, maximum 20 mg/day; adults: 5-10 mg orally every 6-8 hours when required, maximum 40 mg/day

Consider – measures to stop leak

Back
ACUTE
|
open globe injury
|
leaking corneal wound after surgery
Consider – 

measures to stop leak

Additional treatment recommended for SOME patients in selected patient group

If the corneal wound is small and leaking but the anterior chamber remains formed, attempts to stop the leak with pharmacological aqueous-humour suppression (e.g., topical beta-blockers such as timolol or carbonic anhydrase inhibitors such as brinzolamide), patching, or therapeutic contact lens might be considered.

Cyanoacrylate tissue adhesive may be useful for small wounds that fail to seal. [ Cochrane Clinical Answers logo ]

Primary options

timolol ophthalmic: (0.25% or 0.5% solution) children ≥2 years of age and adults: 1 drop into the affected eye(s) once or twice daily

OR

brinzolamide ophthalmic: (1% suspension) adults: 1 drop into the affected eye(s) three times daily

Consider – intravitreal antibiotic injection

Back
ACUTE
|
open globe injury
|
contaminated vitreous
Consider – 

intravitreal antibiotic injection

Additional treatment recommended for SOME patients in selected patient group

Traumatic endophthalmitis may be associated with poor outcomes.

Intravitreal antibiotics (e.g., vancomycin plus ceftazidime or amikacin) should be considered at the time of surgical repair if wound contamination involving the vitreous is present.

Consult local guidance for choice of antibiotics.

Plus – foreign body removal

Back
ACUTE
|
open globe injury
|
with foreign body
Plus – 

foreign body removal

Treatment recommended for ALL patients in selected patient group

The surgical technique for removal of foreign bodies depends on the number and location of the foreign body/bodies in the eye, and their size, shape, and composition.[61]

Risk factors for the development of postoperative retinal detachment include scleral or corneo-scleral entry wound, the size of the foreign body, preoperative retinal detachment, and location of the intra-orbital foreign bodies.[62]

Plus – topical anaesthetic

Back
ACUTE
|
open globe injury
|
with foreign body
Plus – 

topical anaesthetic

Treatment recommended for ALL patients in selected patient group

Remove foreign body under topical ophthalmic anaesthesia (e.g., proxymetacaine, tetracaine) if appropriate.

Primary options

proxymetacaine ophthalmic: (0.5% solution) children and adults: 1-2 drops into the affected eye(s) before procedure

OR

tetracaine ophthalmic: (0.5% solution) children ≥2 years of age and adults: 1 drop into the affected eye(s) before procedure

ONGOING

recurrent corneal erosions or poor healing

1st line – ophthalmology referral and consider surgery

Back
ONGOING
|
recurrent corneal erosions or poor healing
1st line – 

ophthalmology referral and consider surgery

Practitioners should recognise their limitations, and where necessary, seek further advice or refer the patient to an ophthalmologist.

Treat recurrent erosions acutely with topical antibiotics and appropriate analgesia.

Refer patients with multiple recurrences, large defects, or non-healing defects for ophthalmological follow-up. Recurrent or refractory cases usually require surgical intervention (e.g., debridement, stromal micropuncture, phototherapeutic keratectomy, or manual superficial keratectomy).[66][67][68]

After epithelial healing, patients may benefit from treatment with artificial tears, lubricating ointment, and/or topical hyperosmotic agents for weeks or months.[69]

See Corneal abrasions (Management approach) for further detail.

back arrow

Choose a patient group to see our recommendations

Please note that formulations/routes and doses may differ between drug names and brands, drug formularies, or locations. Treatment recommendations are specific to patient groups. See disclaimer

Use of this content is subject to our disclaimer