36 years old man attended A&E department with h/o pain, redness and photophobia in right eye. He had sustained an injury (scratch) to the eye from a tree branch previous the day while gardening.
My Learning:
Corneal abrasion refers to any deficit in the corneal surface epithelium [1].
It can be classified as traumatic (e.g., secondary to foreign body or contact lens) or spontaneous (e.g., herpes simplex infection).
Diagnosis is confirmed with fluorescein dye staining. It should only be done after excluding an open globe injury.
Management consists of administration of topical antibiotics such as Chloramphenicol and for large abrasions, cycloplegics eye drops.
Eye patches are routinely applied as part of treatment, but its benefit has not been proven in the previous studies.
Evidence:
The findings of Cochrane database systemic review published in 2016 are as follows [2].
It included 12 trials which randomised a total of 1080 participants in the review. Four trials were conducted in the United Kingdom, another four in the United States of America, two in Canada, one in Brazil and one in Switzerland.
The primary outcome was healing at 24, 48 and 72 hours while secondary outcomes included measures of pain, quality of life and adverse effects.
People receiving a patch may be less likely to have a healed corneal abrasion after 24 hours compared to those not receiving a patch. Similar numbers of people in the patch and no-patch groups were healed by 48 hours and 72 hours. Participants receiving a patch took slightly longer to heal but the difference was small and probably unimportant (mean difference (MD) 0.14 days longer, 95% CI 0 to 0.27 days longer.
In general, similar pain ratings were seen between patch and no-patch groups.
There was little difference in activities of daily living with the exception of walking which was reported to be more difficult with a patch on.
Bottom line:
Trials included in this review suggest that treating simple corneal abrasions with a patch may not improve healing or reduce pain. In my clinical practice I share this information with my patients and allow them to make an informed decision.
References:
- Corneal abrasions and corneal foreign bodies: Clinical manifestations and diagnosis
https://www.uptodate.com/contents/corneal-abrasions-and-corneal-foreign-bodies-management?search=corneal%20abrasion&topicRef=6897&source=see_link
- Lim CH, Turner A, Lim BX. Patching for corneal abrasion. Cochrane Database Syst Rev. 2016 Jul 26;7(7):CD004764. doi: 10.1002/14651858.CD004764.pub3. PMID: 27457359; PMCID: PMC6457868.