Patching for corneal abrasion

Apr 18 2006

Simple corneal abrasions do not need to be treated by patching the eye, according to a new review of studies that found patching initially slows healing and does not reduce pain.

Although most ophthalmologists no longer use eye patches for minor corneal injuries, some general physicians and emergency room physicians may still be doing so, according to Dr. Angus Turner of the Royal Victorian Eye and Ear Hospital in East Melbourne, Australia.

"The abrasions on the eye normally don’t affect vision too much, so it is pointless rendering a patient acutely monocular if there is no good reason to do so," Turner said.

Turner and a colleague evaluated results from 11 randomized controlled trials of 1014 patients who had experienced a simple, uninfected corneal abrasion. Some studies used antibiotic drops and ointments in addition to patches.

The review appeared in The Cochrane Library, published by The Cochrane Collaboration, an international organization that evaluates medical research. These reviews draw their conclusions about best medical practices based on evidence from several clinical studies on a given topic, after the reviewers consider both the content and quality of these studies.

Abrasions to the cornea, the clear outer layer of the front of the eye, are among the most common injuries to the eye. They generally heal quickly, but are extremely painful. In the past, almost all corneal abrasions were treated by putting a patch on the eye for a day or two. The purpose of the patch was to keep out infection and to keep the eye and lids still to allow the cornea to heal.

But the Cochrane reviewers found that patients who had been treated without patching the eye had faster healing times on the first day of treatment. These patients did not report any significant differences in pain levels when compared to patients who were patched. There were no significant differences in healing or reports of pain two and three days after treatment started.

"It is therefore reasonable to conclude that patching the eye is not useful for the treatment of simple, traumatic corneal abrasions," the researchers say.

The idea of not patching the eye with a corneal abrasion was studied as early as the 1960s, Turner said, and no benefit to patching was observed then. "But that did not seem to be noticed in clinical practice."

"Over time, more trials were completed, but still people in emergency departments all around the world continued to use patches when there was no evidence for their use," Turner said.

"We started moving away from patching after corneal abrasions several years ago," said Edward J. Holland, M.D., director of the cornea service at the Cincinnati Eye Institute. Ophthalmologists first stopped patching eyes that had abrasions due to contact lens wear, because a patch could hide signs of an infection, he said.

"Then we realized that healing rate was no different in these patients," Holland said.

A properly applied eye patch for a corneal abrasion is not comfortable, Holland said, because a patch that can keep the eye still has to be put on rather securely and tightly. He said that not using patches allows more frequent use of antibacterial drops to prevent infection and nonsteroidal anti-inflammatory drops to control pain.

The review found that in most studies using medications, patients who were patched received medication for their eye before the patch was put on and then not for 24 hours, when the patch was removed to re-examine the eye. In these studies, the patients who did not wear a patch received drops or ointments several times over the same period.

Turner and his colleagues are starting to organize of a study whether patching is appropriate for larger abrasions (more than 10 millimeters square).