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Three Part Question

In [a patient with a corneal abrasion] is [antibiotic eye ointment better than antibiotic eye drops] at [making the eye more comfortable]

Clinical Scenario

A carpenter presents to the emergency department complaining that they can feel something in their eye. On examination a foreign body is found and removed leaving a small corneal abrasion. Prophylactic antibiotics are prescribed to prevent infection. The patient tells you it is painful and you wonder whether it is best to give him an ointment or drop preparation of chloramphenicol and if one of them may make the eye more comfortable.

Search Strategy

Ovid MEDLINE(R) 1966 to June Week 2 2006
Embase 1980 to 2006 Week 25
CINAHL 1982 to June Week 2 2006
{[exp Cornea OR exp Eye Injuries OR exp Eye Foreign Bodies] AND [exp Anti-Bacterial Agents OR antibiotic.mp] AND [exp Chloramphenicol OR exp Ophthalmic Solutions OR eye ointment.mp]} LIMIT to [humans and english language]
Cochrane
Corneal abrasions AND Antibiotics

Search Outcome

Medline search resulted in a total of 139 papers. Of which 1 paper was relevant.
Searching Embase, CINAHL and Cochrane gave no further papers.

Relevant Paper(s)

Author, date and country	Patient group	Study type (level of evidence)	Outcomes	Key results	Study Weaknesses
Boberg-Ans, G. Nissen, K R 1998 Feb DENMARK	144 patients with accidental corneal abrasion Randomised into two gruops Gruop 1 - Fucithalmic viscous eye drops Gruop 2 - Chloramphenicol eye ointment	RCT	Corneal healing time	No difference between ointment and drops.	Small study group
			Side Effects	Approximately one third from each group suffered from itching or a mild discomfort. There was no significant difference between the two groups. Data not provided.

Comment(s)

The management of corneal abrasions involves the use of topical antibiotics to prevent infection. There appears to be no evidence to suggest either drops or ointment provides better protection so the choice it is down to if one gives more comfort than the other. Side effects from the RCT (in the table above) were reported to be the same for the use of antibiotic drops and ointment but the preparations were different antibiotics so can not be directly compared. Neither drops or the ointment was said to provide more comfort to the patient while the abrasion healed. Antibiotic ointment is said to be more lubricating and could add to comfort and should therefore be considered as first line treatment. [1] It has been suggested that ointment might reduce vision [2] which could cause problems during the day to the patient. Another paper says ointment might be best used at night [3], perhaps because of this problem. General opinion seems to be that ointment provides better lubrication and therefore comfort to the patient but no clinical data could be found to back this up. References [1]Wilson SA. Last A. Management of corneal abrasions. [Journal Article. Review] American Family Physician. Vol 70(1):123-8, 2004 Jul 1 [2]Harkins T. Managing corneal abrasions. [Journal: Short Survey] Clinical Eye & Vision Care. Vol. 8(4)(pp 275-278), 1996 [3]Wirbelauer C. Management of the red eye for the primary care physician. [Journal Article. Review] American Journal of Medicine. Vol. 119(4):302-6, 2006 Apr

Clinical Bottom Line

No good evidence can be found to say that drops or ointment provides more comfort to the patient with a corneal abrasion.

References

1. Boberg-Ans, G. Nissen, K R Department of Ophthalmology, Gentofte University Hospital, Copenhagen, Denmark. Acta Ophthalmologica Scandinavica 1998 Feb Vol. 76(1):108-11