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Acute Pain | Chronic Pain | General

Corneal abrasion treatment

Clinical bottom line:

Corneal patches do not improve the rate of abrasion recovery or improve pain. Patching is not a useful intervention in the treatment of corneal abrasions.


Corneal abrasions

Corneal abrasions, defects of the normal epithelium usually caused by trauma or removal of a foreign body, account for about 10% of eye hospital emergency visits. Recommended treatments include topical antibiotics, midriatic or cycloplegic drops and eye patching. Eye patching is thought to cause a stable corneal environment to promote re-epithelialisation and reduce pain.

Systematic review

Flynn CA, D'Amico F, Smith G. Should we patch corneal Abrasions? A meta-analysis. Journal of Family Practice 1998; 47:264-270

Inclusion criteria were randomised, controlled trials of eye patch versus no patch; at least 24 hours duration; patients at least six years of age; abrasion due to traumatic injury or removal of a foreign body (excluding contact lenses).

Reviewers extracted data and calculated relative benefits with 95% confidence intervals. These were weighted by trial size.

Findings

Seven trials were found, three of which used florescein to assess healing and four used a slit lamp. Eye patches were of several types of construction, but in essence all used cotton wool, gauze, pads or bandages taped over the eye to keep it closed. Most studies were emergency departments or eye hospitals. Follow up was generally high. Outcomes were not generally assessed by observers unaware of treatment.

Five trials had data suitable for inclusion in an analysis. There was no statistical difference either at day 1 (relative risk 0.87; 0.68 to 1.13) or at day 2 (1.01; 0.65 to 1.55).

Two of the six studies (245 patients) measured pain. There was less pain in the unpatched group, suggesting no benefit of patching.

Figure: Healing rates at days 1 and 2

Adverse effects

Complications were few (four in the patched group, two in the non-patched patients).

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