Abstract
Corneal abrasions are one of the most common ocular injuries seen in the emergency department. While most patients with corneal abrasions complain of excruciating pain, permanent sequelae may develop if not managed properly. The use of topical antibiotics and other standards of treatment have greatly reduced the incidence of complications. However, there is still a lack of consensus regarding the proper management of pain in corneal abrasions. Proposed analgesics for the control of corneal abrasion pain include topical nonsteroidal anti-inflammatory drugs (NSAIDs), topical anesthetics, and topical cycloplegics. For this review, ten published randomized controlled trials were identified, focusing on the efficacy and safety of different topical analgesics used in treating corneal abrasions. Six of the trials focused on topical NSAIDs, three on topical anesthetics, and one on topical cycloplegics. There were mixed results regarding the efficacy of topical analgesics in reducing pain in patients with corneal abrasions. This review of the literature revealed that topical NSAIDs produced reductions in pain symptoms, whereas topical anesthetics and cycloplegics did not demonstrate significant improvements in either healing rates or pain control. Thus, this evidence supports the use of topical NSAIDs in the standard management of corneal abrasions. Unfortunately, the power of these studies is largely limited by small sample sizes. Larger studies must be conducted before topical analgesics can be recommended or discouraged for pain management in corneal abrasions. However, based on this review of the literature, the use of topical NSAIDs does not appear to complicate wound healing, and thus remains a safe option in patients desiring medical treatment.
Highlights
BackgroundCorneal abrasions account for a large portion of eye-related injuries seen with an incidence of approximately 3 in 1000 persons presenting to the emergency room [1]
While topical ophthalmologic solutions are commonly given to patients presenting to the emergency department for corneal abrasions, there has been limited progress in establishing specific guidelines to stratify the best treatment option
Patients with corneal abrasions are typically treated with a minimum of topical antibiotics to reduce the risk of infection, but the protocol for optimal pharmacological pain management remains a topic of debate
Summary
Corneal abrasions account for a large portion of eye-related injuries seen with an incidence of approximately 3 in 1000 persons presenting to the emergency room [1]. Studies have demonstrated a significant reduction in supplementary oral analgesic use when ophthalmic NSAIDs were applied [5, 6]. A study by Waldman et al demonstrated higher patient-reported effectiveness of topical tetracaine, a local anesthetic, compared to saline; the research group recommended that short-term local anesthetic use become a standard practice of corneal abrasion management [8]. The purpose of this literature review is to perform an analysis of current available research and to determine the effectiveness of topical analgesics on reducing pain in patients with corneal abrasions. This review seeks to determine which topical analgesic is best supported by literature to provide pain relief following patients with corneal abrasions.
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