The management of corneal abrasions in accident and emergency

Abstract

Recent debate over the use of eyepads and mydriatics for corneal abrasions in ophthalmology departments (Mindin et al., 1996, JAMA 1996; 27: 837) has prompted this review of the management of small corneal abrasions ( < 60% of cornea) in a large teaching hospital accident and emergency (A&E) department. Ninety-nine patients were studied who presented to the Leicester Royal Infirmary A&E Department with a corneal abrasion: 49 were given an eye pad and 50 were not given an eye pad. All patients received chloramphenicol (1%) ointment. There was no significance difference between the two groups in terms of the duration of pain (p > 0.2). Four patients developed corneal infections (two wore an eyepad, two had no eye pad). There was only one patient who suffered a transient but significant reduction in visual acuity ( 6 9 - 6 18 ), following the use of an eye pad and subsequent diagnosis in eye casualty of a dendritic ulcer. It is concluded that accident and emergency treatment of small corneal abrasions is safe and effective if an eye pad is not given. Previous criticisms of A&E management of eye problems (Nayeen and Stansfield, Archs Emerg Med, 1992; 9: 257) are unfounded in this department.