Eye patches are not indicated for simple corneal abrasions
Date First Published:
March 1, 2000
Last Updated:
April 11, 2001
Report by:
Kevin Mackway-Jones, Consultant (Manchester Royal Infirmary)
Search checked by:
Simon Carley, Manchester Royal Infirmary
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.
Search Details:
{[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].
Outcome:
41 papers found of which 28 irrelevant and 4 of insufficient quality for inclusion
Relevant Paper(s):
| Study Title | Patient Group | Study type (level of evidence) | Outcomes | Key results | Study Weaknesses |
|---|---|---|---|---|---|
| Efficacy of eyepad in corneal healing after corneal foreign body removal. 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 | ||||
| No eye pad for corneal abrasion. Kirkpatrick JN, Hoh HB, Cook SD. 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 | |
| Eye patch treatment for the pain of corneal abrasion. Patterson J, Fetzer D, Krall 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 | ||||
| A comparison of pressure patching versus no patching for corneal abrasions due to trauma or foreign body removal. 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. | ||||
| The evaluation of eye patching in the treatment of traumatic corneal epithelial defects. Campanile TM, St Clair DA, Benaim M. 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 |
| The management of corneal abrasions in accident and emergency. Hart A, White S, Conboy P et al. 1997 UK | 99 patients with corneal abrasion Eye pad vs no eye pad |
Controlled trial | Duration of pain | No significant difference | |
| Should we patch corneal erosions? Arbour JD, Brunette I, Boisjoly HM 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 |
Author Commentary:
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.
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.
- Kirkpatrick JN, Hoh HB, Cook SD.. No eye pad for corneal abrasion.
- Patterson J, Fetzer D, Krall J et al.. Eye patch treatment for the pain of corneal abrasion.
- Kaiser PK.. A comparison of pressure patching versus no patching for corneal abrasions due to trauma or foreign body removal.
- Campanile TM, St Clair DA, Benaim M.. The evaluation of eye patching in the treatment of traumatic corneal epithelial defects.
- Hart A, White S, Conboy P et al.. The management of corneal abrasions in accident and emergency.
- Arbour JD, Brunette I, Boisjoly HM et al.. Should we patch corneal erosions?