Key messages
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People with corneal abrasions (scratches to the transparent, protective outer layer of the eye) are at a higher risk of developing ocular infections.
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We performed an update to the previously published review but did not find enough evidence that eye drops or ointments containing antibiotics have benefit compared with placebo (dummy treatment), or over another type of antibiotics to prevent eye infections or speed up healing following corneal abrasion.
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Similar numbers of people experienced mild unwanted effects from antibiotics, such as irritation or allergic reactions, regardless of the antibiotics received.
What is a corneal abrasion?
The cornea is the transparent, protective outer layer of the eye. A corneal abrasion is a scratch of the cornea, usually caused by mechanical trauma, a foreign object in the eye, chemical burns, or contact lenses.
How is corneal abrasion managed?
Corneal abrasion causes pain and irritation, so treating healthcare professionals prescribe painkillers to help ease the pain. Some may also prescribe antibiotics to prevent eye infections.
What did we want to find out?
We wanted to find out whether antibiotic eye drops or ointments can prevent eye infection following a corneal abrasion. We collected and analyzed all relevant studies to answer this question. We also wanted to find out whether antibiotics cause unwanted effects.
What did we do?
We searched the medical literature for studies that tested antibiotics to prevent eye infection following a corneal abrasion. We compared and summarized the results of these studies and rated our confidence in the evidence based on factors such as study method and sample size.
What did we find?
We found four randomized controlled trials (studies where participants are randomly assigned to one of two or more treatment groups) with a total of 998 people. Two studies were conducted in the United Kingdom, one in Denmark, and one in South Korea. Most participants had corneal abrasions caused by trauma or following the removal of a foreign object from the eye. The studies compared eye drops or ointment containing antibiotics with either another antibiotic or a non-antibiotic placebo (dummy treatment). All studies were conducted more than two decades ago. Two studies received support from pharmaceutical companies.
The studies showed very uncertain evidence about whether antibiotics help prevent eye infection in people with corneal abrasions. In one study, antibiotics may have slightly increased the number of people who developed eye infections, but the evidence was not strong enough to draw firm conclusions. There was probably little to no difference in healing within 48 hours between people who used antibiotics and those who used placebo or other types of antibiotics. None of the included studies examined pain reduction by half or more after one day, vision change at one month, change in pain level during the first day, and any problem caused by corneal abrasion during the study period.
The unwanted effects from treatment, such as irritation or allergic reactions, were generally mild and occurred in a similar number of people in all treatment groups. In one study, around one in three participants experienced discomfort or itching, regardless of the treatment received.
Overall, the results suggest that there is not enough high-quality evidence to support or refute the use of topical antibiotics to prevent infection or improve healing in people with corneal abrasions.
What does the evidence mean?
Due to a lack of robust evidence, we do not know whether the use of antibiotics can prevent eye infections in people with corneal abrasion or whether one antibiotic is better than another for this purpose.
How up-to-date is the evidence?
The evidence is current to 28 March 2025.
Read the full abstract
Corneal abrasion is a common disorder frequently faced by ophthalmologists, emergency physicians, and primary care physicians. Ocular antibiotics are one of the management options for corneal abrasion. A comprehensive summary and synthesis of the evidence on antibiotic prophylaxis in traumatic corneal abrasion is thus far unavailable, therefore we conducted this review to evaluate the current evidence regarding this important issue.
Objectives
To assess the benefits and harms of topical antibiotic prophylaxis for corneal abrasion.
Search strategy
We searched CENTRAL, MEDLINE, Embase.com, two other databases, and two trials registries together with reference checking to identify studies that are included in the review. The latest search date was 28 March 2025.
Selection criteria
We included randomized controlled trials (RCTs) comparing antibiotic with another antibiotic or placebo in children and adults with corneal abrasion due to any cause.
Data collection and analysis
We used standard Cochrane methodology and assessed the certainty of the body of evidence for the prespecified outcomes using the GRADE classification.
Main results
Our search of the electronic databases yielded 8661 records. We screened 7690 titles and abstracts after removal of duplicates. We retrieved 32 full-text reports for further review. We included two studies that randomized a total of 527 eyes of 527 participants in the review. One study was conducted in Denmark, and one was conducted in India.
The two studies did not examine most of our prespecified primary and secondary outcomes. The first study was a parallel-group RCT comparing chloramphenicol ocular ointment with fusidic acid ocular gels (frequency was not clearly reported). This study enrolled 153 participants older than 5 years of age with corneal abrasion in Denmark with a one-day follow-up duration. No participants had secondary infection in the fusidic acid group, whereas three (4.1%) participants in the chloramphenicol group had a slight reaction (risk ratio [RR] 0.15, 95% confidence interval [CI] 0.01 to 2.79; 144 participants; very low certainty evidence). Thirty-one (44.3%) participants in the fusidic acid arm and 34 (46.6%) participants in the chloramphenicol arm were cured (defined as the area of abrasion zero and no infection) at day 1 (RR 0.94, 95% CI 0.65 to 1.34; 144 participants; very low certainty evidence). Without providing specific data, the study reported that the degree of pain was not affected by the interventions received. The most common adverse events reported were itching and discomfort of the eye, which occurred in approximately one-third of participants in each group (low certainty evidence).
A second multicenter, two-arm RCT conducted in India enrolled 374 participants older than 5 years of age with corneal abrasion who presented within 48 hours after injury. This study investigated the effect of a three-day course of either ocular ointment combinations of chloramphenicol-clotrimazole or chloramphenicol-placebo (all three times daily). At day 3, 169 (100%) participants in the chloramphenicol-clotrimazole arm and 203 (99%) out of 205 participants in the chloramphenicol-placebo arm were cured without any complication, defined as complete epithelialization of the cornea without evidence of infection (RR 1.01, 95% CI 0.99 to 1.03; 374 participants; very low certainty evidence). Four participants assigned to the chloramphenicol-placebo arm experienced mild adverse events: two participants (1%) had mild chemosis and irritation, and two (1%) had small single sterile corneal infiltrates (low certainty evidence).
Authors' conclusions
Given that the evidence supporting antibiotic use in corneal abrasion is of very low certainty, we are not able to support a specific antibiotic regimen or draw conclusions about the effects of antibiotic prophylaxis in preventing ocular infection or accelerating epithelial healing. Future research could explore adequately powered RCTs or alternative approaches, such as target trial emulation, while focusing on high-risk populations and antibiotic formulations.
Funding
The Cochrane Eyes and Vision US Project is supported by grant UG1EY020522, National Eye Institute, National Institutes of Health.
Registration
Protocol (2021) DOI: 10.1002/14651858.CD014617
Original Review (2022) DOI: 10.1002/14651858.CD014617.pub2
