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Topical NSAID for corneal abrasions

Clinical bottom line

The quality and quantity of evidence is insufficinet to be certain about the efficacy and safetly of topical NSAIDs for corneal abrasions.


Reference

LA Calder et al. Topical nonsteroidal anti-inflammatory drugs for corneal abrasions: meta-analysis of randomised trials. Academic Emergency Medicine 2005 12: 467-473.

Searching

A number of electronic journals were searched, as well as four ophthalmology and emergency medicine journals, and pharmaceutical companies selling topical NSAIDs contacted to mid-2004. Published or unpublished randomised trials were sought, in any language, that examined topical NSAID for corneal abrasions with pain as an outcome. Corneal ulcers, and studies in the perioperative setting, were not included.

The primary outcome sought was pain at 24 hours.

Results

There were 11 randomised trials, five with useable data. Trial size was 22 to 347 patients, with a median of 85. Topical NSAIDs used include indomethacin, flurbiprofen, ketorolac, diclofenac, and piroxicam, at various strengths, as drops. Controls were usually placebo drops, or usual treatment.

The five studies with pain scores had three with 459 patients with poolable data. There was a significantly reduced pain score at 24 hours, though one trial in this analysis was not double blind. Insufficient information was available to examine adverse events.

Comment

There is limited information about topical NSAIDs for corneal abrasions, but what little we have indicates that they reduce pain at 24 hours, but that conclusion depends upon studies subject to bias. The quality and quantity of evidence is insufficient to be certain about the efficacy and safety of topical NSAIDs for corneal abrasions.