Three Part Question
In [patients with superficial corneal abrasions] is [an eye patch better than no eye patch] at reducing [pain and time to healing]
Clinical Scenario
A young woman attends the Emergency Department with pain in her right eye. Her infant son has inadvertently put his hand in her eye. Examination reveals a corneal abrasion. You wonder whether an eye patch should be applied to protect the cornea.
Search Strategy
Medline 1966-12/98 using the OVID interface.
{[exp eye injuries OR exp eye foreign bodies OR corneal abrasion$.mp] AND [exp bandages OR eye patch$.mp OR patch$.mp]} AND [maximally sensitive RCT filter].
Search Outcome
41 papers found of which 28 irrelevant and 4 of insufficient quality for inclusion
Relevant Paper(s)
Author, date and country |
Patient group |
Study type (level of evidence) |
Outcomes |
Key results |
Study Weaknesses |
Hulbert MF 1991 UK | 30 patients with corneal abrasion after foreign body removal
Chloramphenicol and eye patch vs chloramphenicol alone | PRCT | Discomfort | Greater at 24h | |
Time to healing | No difference |
Kirkpatrick JN et al 1993 UK | ** patients with simple traumatic corneal abrasions
Antibiotic, mydriatic and eye patch vs antibiotic and mydriatic alone | PRCT | Time to healing | Significantly <0.05) better in antibiotic alone group | |
Patterson J et al 1996 USA | 33 patients with eye pain and corneal abrasion
Eye patch vs no eye patch | PRCT | Pain score | No difference | Small study - low power |
Analgesic use | No difference |
Kaiser PK 1997 USA | 201 patients with non-infected non contact lens related traumatic (120) or post foreign body removal (81) corneal abrasions.
Antibiotic, mydriatic and eye patch vs antibiotic and mydriatic alone | PRCT | Pain | Significantly less in antibiotic/mydriatic alone group | |
Time to healing | Significantly less in antibiotic/mydriatic alone group |
Blurred vision | Significantly less in antibiotic/mydriatic alone group for traumatic abrasions, no difference for abrasions post foreign body removal. |
Campanile TM et al 1997 USA | 64 patients with traumatic corneal abrasion
Patched vs unpatched | PRCT | Rate of healing at day 1 | Significantly faster in unpatched | Only recorded at 1 day |
Hart A et al 1997 UK | 99 patients with corneal abrasion
Eye pad vs no eye pad | Controlled trial | Duration of pain | No significant difference | |
Arbour JD et al 1997 Canada | 48 eyes (46 patients) with corneal erosion
Patching vs no patching | PRCT | Linear and surface speed of reepithelialisation | No significant difference | |
Pain | No significant difference |
Insomnia | No significant difference |
Comment(s)
There are 6 PRCTs of varying quality and power in this area. All show no benefit from patching and the largest shows positive benefit from no patch.
Clinical Bottom Line
Patients with corneal abrasion should not have an eye patch.
References
- Hulbert MF. Efficacy of eyepad in corneal healing after corneal foreign body removal. Lancet 1991;337:643.
- Kirkpatrick JN, Hoh HB, Cook SD. No eye pad for corneal abrasion. Eye 1993;7:468-71.
- Patterson J, Fetzer D, Krall J et al. Eye patch treatment for the pain of corneal abrasion. South Med J 1996;89:227-229.
- Kaiser PK. A comparison of pressure patching versus no patching for corneal abrasions due to trauma or foreign body removal. Opthalmol 1995;102:1936-1942.
- Campanile TM, St Clair DA, Benaim M. The evaluation of eye patching in the treatment of traumatic corneal epithelial defects. J Emerg Med 1997;15:769-774.
- Hart A, White S, Conboy P et al. The management of corneal abrasions in accident and emergency. Injury 1997;28:527-529.
- Arbour JD, Brunette I, Boisjoly HM et al. Should we patch corneal erosions? Arch Opthalmol 1997;115:313-317.