Scratching the Surface: Re-evaluating the Management of Corneal Abrasions

This narrative review examines the current evidence on the pathophysiology, clinical evaluation, and management of corneal abrasions, while highlighting areas of variability and ongoing controversy in clinical practice. Corneal abrasions are among the most common causes of ocular pain presenting to emergency departments. Although often self-limited, delayed diagnosis or inappropriate management can result in serious complications, including infectious keratitis, corneal ulceration, and permanent vision loss. These injuries are managed by multiple healthcare specialties, including emergency medicine, primary care, optometry, and ophthalmology, which may contribute to the variability in treatment approaches and the lack of standardized, evidence-based protocols. Diagnosis is primarily clinical and relies on careful history, visual acuity assessment, fluorescein staining, and exclusion of penetrating injury or infection. Management options include topical antibiotics, oral and topical analgesics, nonsteroidal anti-inflammatory drugs (NSAIDs), cycloplegics, bandage contact lenses, and supportive care. However, many commonly used interventions lack robust prospective evidence, and practice patterns vary widely. A key area of controversy involves the outpatient use of topical anesthetic agents for pain control. While limited short-term use has been proposed in selected settings, concerns persist regarding epithelial toxicity, adherence, and patient safety. This review synthesizes perspectives across specialties to delineate areas of agreement and uncertainty, highlighting the need for high-quality clinical studies with standardized outcomes to inform evidence-based management of corneal abrasions.