Topical non-steriodals reduce pain in corneal abrasions
Date First Published:
August 8, 2005
Last Updated:
August 25, 2005
Report by:
Mohammed Ziaei & Simon Carely, Medical student & Consultant in Emergency Medicine (Manchester Royal Infirmary)
Search checked by:
Bruce Martin, Manchester Royal Infirmary
Three-Part Question:
[In adults with acute corneal abrasions] are [non-steroidal eye drops better than simple lubrication] at [improving pain relief and improving time to healing.]
Clinical Scenario:
A 25 year old man presents to the emergency department complaining of a 4 hour history of painful right eye after it was scratched by his 3 month old daughter. You recall being told that topical non-steroidal may be of help but wonder if they are any better than lubrication on its own. You also wonder if the non-steroidals may affect the eventual outcome and time to healing.
Search Strategy:
Medline 1966-10/05 using the OVID interface.
Pubmed
Pubmed
Search Details:
Medline: ({[exp cornea OR cornea.ti,ab,rw,sh] AND abrasion$.ti,ab,rw,sh} AND [exp analgesia OR analgesi$.ti,ab,rw,sh OR exp anti-inflammatory agents, non-steroidal OR non-steroidal.ti,ab,rw,sh])
Pubmed: Corneal abrasions and NSAID's
Pubmed: Corneal abrasions and NSAID's
Outcome:
16 papers found of which 10 were relevant. However only the very recent high quality meta analysis of the other studies was used to update the original BET.
Relevant Paper(s):
| Study Title | Patient Group | Study type (level of evidence) | Outcomes | Key results | Study Weaknesses |
|---|---|---|---|---|---|
| Topical analgesia for superficial corneal injuries. Brahma AK, Shah S, Hillier VF et al. 1996 UK | 401 patients with corneal abrasions in an eye emergency department. All patients received chloramphenicol ointment +/- study drops: polyvinyl alcohol alone, homatropine 2%, flubriprofen 0.03% or homatropine 2% + flubriprofen 0.03% |
PRCT | Ocular pain 6 hourly | Both patient groups receiving flubriprofen had significantly less pain. There was no added benefit when homatropine was given with flubriprofen. | Very low response rate, only 55.8% of patients enrolled in the study completed it. |
| The effectiveness of topical diclofenac in relieving discomfort following traumatic corneal abrasions. Jayamanne DG, Fitt AW, Dayan M et al. 1997 UK | 40 patients with unilateral traumatic corneal abrasions. All patients received chloramphenicol ointment +/- study drops: diclofenac sodium 0.1% or normal saline |
PRCT | Day 2 | Less in diclofenac group (P < 0.001) | |
| Ocular pain: | Less in diclofenac group (P < 0.02) | ||||
| Day 1 | |||||
| A study of topical nonsteroidal anti-inflammatory drops and no pressure patching in the treatment of corneal abrasions. Kaiser PK, Pineda R 2nd. 1997 USA | 100 patients with traumatic or foreign body related corneal abrasions All patients received a cycloplegic and polymixin B +/- study drops: ketorolac tromethamine 0.5% or control vehicle drops |
PRCT | Healing time | No difference | |
| Complication rate | No difference | ||||
| Foreign body sensation | Less in ketorolac group from day 1 (P < 0.003) | ||||
| Photophobia | Less in ketorolac group from day 1 (P < 0.009) | ||||
| Ocular pain | Less in ketorolac group from day 1 (P < 0.002) | ||||
| Topical nonsteroidal anti-inflammatory drugs for corneal abrasions: meta-analysis of randomized trials. Calder LA, Balasubramanian S, Fergusson D. 2005 Canada | 459 patients with corneal abrasions in the emergency department or ophthalmology clinic receiving topical NSAID's +/- cointevention. | Meta-analysis | Ocular pain score at 24 hours: | Mean reduction in pain score by 1.30 points on the 0-10 pain scale (P < 0.00001). | Variable level of quality of the 11 trials as well as the use of different pain scales and cointerventions. Possibility of publication bias. |
| Adverse effects of NSAID's: | Insufficient data for a meta-analysis but transient stinging was noted as common adverse effect. |
Author Commentary:
The trials all investigated different non-steroidal agents. No studies have been done to compare the relative merits of these drugs. Furthermore no trials comparing topical and oral preparations appear to have been done.
Bottom Line:
Non-steroidal anti-inflammatory agents are effective topical analgesics for traumatic corneal abrasions and do not appear to affect time to healing. However the lack of trials comparing oral and topical analgesia together with the cost of these preparations must be considered before these preparations are introduced.
References:
- Brahma AK, Shah S, Hillier VF et al.. Topical analgesia for superficial corneal injuries.
- Jayamanne DG, Fitt AW, Dayan M et al.. The effectiveness of topical diclofenac in relieving discomfort following traumatic corneal abrasions.
- Kaiser PK, Pineda R 2nd.. A study of topical nonsteroidal anti-inflammatory drops and no pressure patching in the treatment of corneal abrasions.
- Calder LA, Balasubramanian S, Fergusson D.. Topical nonsteroidal anti-inflammatory drugs for corneal abrasions: meta-analysis of randomized trials.