A 44-year-old woman presents with eye pain that worsens when opening the eye. After placing proparacaine drops, her pain markedly improves, and VA is 20/20. The fluorescein exam is shown. What is the most appropriate next step?

• A. Erythromycin Ointment
• B. Ciprofloxacin Eye Drops
• C. Prednisolone Drops
• D. No treatment; self-resolve

Answer: (A)

The situation points to a corneal abrasion. The pain is from the corneal surface, it improves with a topical anesthetic, visual acuity remains normal, and fluorescein staining would show an epithelial defect on the cornea. The priority is to protect the healing surface from infection while it regenerates.

Starting a broad-spectrum ophthalmic antibiotic ointment is the best next step to prevent bacterial infection as the epithelium heals. Erythromycin ointment is a classic, convenient choice for uncomplicated corneal abrasions because it covers common ocular surface bacteria and is easy to apply, with minimal risk to the cornea. Steroids are not used initially because they can delay healing and mask infection. Not treating would risk infection or slower recovery, and while other antibiotics (like fluoroquinolone drops) are options, erythromycin ointment is a standard first-line choice for this presentation. Advise avoiding contact lens wear, rubbing the eye, and arrange prompt follow-up (within 24 hours) or sooner if symptoms worsen.