How should I manage a patient with a corneal abrasion who presents with significant pain and photophobia?

Management of a patient with corneal abrasion presenting with significant pain and photophobia:

• Perform a thorough eye examination including visual acuity assessment and fluorescein staining to confirm the abrasion and exclude foreign bodies or other complications ¹.
• Remove any loose superficial foreign bodies if expertise and equipment are available; use topical anaesthetic (one drop of proxymetacaine 0.5%) to aid removal but avoid repeated doses due to toxicity and delayed healing ¹.
• Advise the patient to avoid touching or rubbing the eye and to avoid contact lens use until healing is complete ¹.
• Provide symptom relief with simple oral analgesics such as paracetamol; topical analgesics and cycloplegics are not recommended as they do not improve healing or pain and may cause adverse effects ¹.
• Recommend ocular lubricants (non-prescription lubricating eye drops or ointment) to alleviate discomfort; eye drops may be preferred during the day and ointments at night ¹.
• Advise wearing sunglasses or staying in low light environments to reduce photophobia and light sensitivity ¹.
• Consider prescribing a broad-spectrum topical antibiotic such as chloramphenicol if there is a risk of infection, especially if the abrasion is contaminated or associated with foreign matter; continue antibiotics until 24 hours after symptoms resolve ¹.
• Do not routinely use eye patches as evidence does not support benefit in healing or pain reduction ¹.
• Arrange follow-up within 24 hours to reassess symptoms and healing; instruct the patient to seek urgent review if symptoms worsen, vision decreases, or signs of infection develop ¹.
• Refer urgently to ophthalmology if there is significant visual acuity reduction, increasing size of abrasion, corneal infiltrate, ulcer, infection, or if the abrasion does not heal within 3–4 days ¹.