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Three Part Question

[In adults with simple corneal abrasions] does [simple lubrication]decrease [long term ocular symptoms?]

Clinical Scenario

A 42 year old man presents to the emergency department complaining of a 6 hour history of painful right eye after it was scratched by a twig during gardening. The clinician advises the patient to use lubricants as a prophylactic measure against Recurrent Corneal Erosion (RCE) syndrome. You wonder whether there's any evidence to support this decision.

Search Strategy

Medline 1966-2005 using the OVID interface.
({[exp cornea OR cornea.ti,ab,rw,sh] AND abrasion$.ti,ab,rw,sh} AND [exp lubrication OR ophthalmic solutions]

Search Outcome

6 papers were found of which 1 was relevant.

Relevant Paper(s)

Author, date and country	Patient group	Study type (level of evidence)	Outcomes	Key results	Study Weaknesses
Eke T et al 1999 UK	74 patients with traumatic corneal abrasions. 52 (20 caused by fingernail and 32 from other causes) were treated with cyclopentolate ointment 1% immediately and chloramphenicol eye drops four times daily for 5 days. 22 received the above regimen and a lubricating ointment (Lacrilube).	PRCT	Ocular symptoms (pain, grittiness, photophobia, or watering) at 3 months	No significant difference in symptom prevalence between "fingernail" and "non-fingernail" injuries managed with standard regimen (p=0.54). Treatment of fingernail injuries with additional nightly ointment was associated with a higher prevalence of symptoms at 3 months (p = 0.016).	Small non-blinded study.

Comment(s)

The use of lubricants is traditional and common practice for the treatment of corneal abrasions. However, there is no good evidence to support this. The only study pertinant to the three part question is flawed due to a number of compounding factors mentioned above. However, even this study found no benefit for lubricants in the management of corneal abrasions.

Clinical Bottom Line

The results of this literature review suggest that nightly lubricating ointment does not prevent recurrent symptoms following uncomplicated traumatic corneal abrasion. Instead, the only relevant study in this are found that they increase morbidity of such patients. Therefore lubricants cannot be recommended for use in patients with corneal abrasion.

References

1. Eke T. Morrison DA. Austin DJ. Recurrent symptoms following traumatic corneal abrasion: prevalence, severity, and the effect of a simple regimen of prophylaxis. Eye 13 (Pt 3a):345-7, 1999