Management Of Corneal Abrasions Research Articles

Use of Topical Anesthetics in the Management of Patients With Simple Corneal Abrasions: Consensus Guidelines From the American College of Emergency Physicians

The management of corneal abrasions has largely excluded dispensing topical local anesthetics for home use due to concern for corneal toxicity. We have reviewed and critically appraised the available literature evidence regarding the use of topical anesthetics in patients with simple corneal abrasions. Using sequential Delphi review, we have developed these clinical guidelines. Herein are evidentiary summaries and consensus recommendations for 8 specific relevant questions. Our key observation is that for only simple corneal abrasions, as diagnosed and treated in accordance with the full protocol described herein, it appears safe to prescribe or otherwise provide a commercial topical anesthetic (ie, proparacaine, tetracaine, oxybuprocaine) for use up to every 30 minutes as needed during the first 24 hours after presentation, as long as no more than 1.5 to 2 mL total (an expected 24-hour supply) is dispensed and any remainder is discarded after 24 hours. Importantly, although published findings suggest absent harm for short courses, more rigorous studies with a greater cumulative sample size and ophthalmologic follow-up are needed.

Efficacy of Topical Analgesics in Pain Control for Corneal Abrasions: A Systematic Review.

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.

Corneal abrasion: assessment and management

Corneal abrasions result from a superficial lesion to the most anterior aspect of the eye, the corneal epithelium. Patients can present to the GP with an array of symptoms including pain, foreign body sensation, decreased visual acuity/blurring, epiphora (excess watering) and photophobia. Most corneal abrasions are self-limiting and appropriate management can be instituted in the GP surgery. However, some require referral for specialist ophthalmology assessment. This article looks at the assessment and management of corneal abrasions and provides evidence-based guidance for ophthalmology referral.

Management of corneal abrasions and ocular trauma in children.

Management of corneal abrasions and ocular trauma in children.

National survey of corneal abrasion treatment.

To survey the different methods used in the management of corneal abrasions (including iatrongenic cases) nationally. A questionnaire survey of all 162 ophthalmic units in the UK was carried out in 1997. The response rate was 134 of 162 (83%). The majority of units do not have an established policy for the treatment of corneal abrasions. Topical antibiotic alone and antibiotic together with a cycloplegic are the commonest immediate treatments, whilst the most common treatment course is topical antibiotic. Padding and patient follow-up is practised some of the time by most units and all of the time by the remaining minority. Use of a soft bandage contact lens is uncommon. There is no statistically significant difference (p > 0.05) between the policy-holders and non-policy-holders in their use of the various topical regimes, padding and soft bandage contact lens. The traditional trio of topical antibiotic, cycloplegic and padding is still the mainstay of corneal abrasion treatment amongst units nation-wide. However, there is a lack of reproducible scientific evidence to support this treatment. Larger randomised trials looking at the efficacy of the different treatment options are needed.

The management of corneal abrasions in accident and emergency

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.

The Management of Corneal Abrasions and Corneal Foreign Bodies

The Management of Corneal Abrasions and Corneal Foreign Bodies