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Ciprofloxacin eye drops for corneal abrasion

Corneal abrasions heal with time. Prophylactic topical antibiotics are given in patients with abrasions from contact lenses. Traditionally, topical antibiotics were used for prophylaxis even in noninfected corneal abrasions not related to contact lenses, but this practice has been called into question.

Patching the eye has been used to help relieve the pain associated with corneal abrasion, but research has not shown benefit from patching. [20, 21, 22] Patching should not be performed in patients at high risk of infection, such as those who wear contact lenses and those with trauma caused by vegetable matter, because of potential incubation of infecting organisms and promoting subsequent infectious keratitis.

Some ophthalmologists advocate the use of diclofenac (Voltaren) or ketorolac (Acular) drops with a disposable soft contact lens in addition to antibiotic drops. [23, 24, 25] This therapy may be an effective alternative to patching, as it allows the patient to maintain binocular vision during treatment and reduces inflammation.

Patients with all but the most minor abrasions usually require a strong oral narcotic analgesic initially. In addition, topical cycloplegics may be required to relieve pain and photophobia in patients with large abrasions until their healing is nearly complete.

Emergent ophthalmologic consultation is warranted for suspected retained intraocular foreign bodies. Urgent consultation is needed for suspected corneal ulcerations (microbial keratitis).

Treatment considerations

Determining the best treatment for a corneal abrasion depends on many factors, such as the severity of the injury and the degree of pain the patient is experiencing. But practitioners also must take into consideration the location of the abrasion, symptoms the patient may be exhibiting, and how the incident occurred. Was it simply a scratch or a shearing injury that tore the epithelium away from the underlying basement membrane? Was it caused by a plant-type material, a situation in which a later fungal infection may be possible?

The level of pain also figures into the treatment plan. Moreover, pain affects everyone differently, so pain management must be tailored to each individual. Two patients with essentially identical wounds or injuries may describe the pain level very differently. It is important to understand that pain is individual. When attempting to manage pain associated with corneal abrasion, the pain management approach must be based on the patient’s pain rather than the patient’s injury.

Any symptoms that a patient may display also helps decide the course of treatment. If the patient is experiencing significant sensitivity to light or excessive lacrimation, he or she should be treated differently from someone who has a small abrasion with minor symptoms. It also depends on the location of the injury. If it is central, the treatment plan should be more aggressive than if the injury is peripheral.

As the demand for refractive surgery grows, practitioners are more likely to see different types of corneal abrasions stemming from a surgical procedure.

Refractive surgery has reawakened the interest in treating corneal abrasions because many postrefractive surgery patients develop some mild degree of what would be considered an abrasion. Photorefractive keratectomy by intention causes a fairly substantial epithelial defect, which clearly goes beyond just an abrasion. In laser in situ keratomileusis (LASIK), although there is not a massive area of open abrasion, there are peripheral areas of the cornea where the flap edge may exhibit a circumferential pattern of superficial punctate keratitis adjacent to the microkeratome cut. Many ophthalmologists have reacquainted themselves with this, in terms of refractive surgery offering unusual created abrasions that do not always completely heal.

Preventing recurrent erosion

While monitoring the cornea for signs that the tissue is healing, a bland lubricating ointment ciprofloxacin eye drops for corneal abrasion for 6-8 weeks to reduce the potential for recurrent erosion or a hypertonic ointment, depending on the appearance of the cornea, should be considered.

Hyperosmotic agent ointment (sodium chloride 5%) every night, in addition to a daily hypertonic drop, for 60 days should be considered.

If recurrent erosion can be prevented, the patient has been well served. Recurrent erosion can become a lifelong problem. Many patients with recurrent erosion eventually require laser procedures or corneal stromal micropuncture.

Unresolved corneal erosions present a challenge in terms of treatment.


Source: http://emedicine.medscape.com/article/1195402-treatment


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