For corneal abrasions, I give (1) nothing, (2) tetracaine drops, (3) eye ointment, or (4) patch the eye.
Corneal abrasions are about pain and patient comfort, so I don’t have a standard rx.
Minimal / no pain – nothing
A little pain – po meds, maybe ophth ointment at night
Moderate pain – tetracaine drops
A lot of pain + fear of light – ophth ointment, patch eye for a day or two, po pain killers
Topical tetracaine is safe to use for a day or so (ref). There aren’t a lot of trials comparing different treatments, and all such RCTs are limited in their patient selection (randomizing a patient with minimal pain to patch v no patch is silly). I’m a long-time contacts wearer; I’m pretty sure my cornea has become less sensitive over the years, so I usually need nothing. As far as I know, there is no RCT justifying the use of topical abx drops in corneal abrasions. I’ve seen only one infected corneal abrasion, and I’ve seen one person find out they were allergic to sulfur after they were given prophylactic abx drops for a corneal abrasion.
When you see a corneal abrasion, make sure it’s not a corneal ulcer. An injury that looks like there’s some depth to it needs to be treated with respect (and an ophthalmologist). Give these patients prophylactic abx drops.
Funny enough, there was an article published in annals em after I started this blurb.
https://www.ncbi.nlm.nih.gov/pubmed/28483289