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Three Part Question

[In patients with simple corneal abrasions] is [a cycloplegic better than simple lubrication] at [reducing pain and discomfort]?

Clinical Scenario

A 20 year old man presents to the emergency department with a history of something having blown into his eye. Clinical examination reveals a small abrasion to the cornea. You prescribe chloramphenicol ointment and discharge the patient. A friendly Ophthalmologist suggests that you should have given a dilating drop as well. You wonder if there is any evidence to support this.

Search Strategy

Medline 1966-12/00 using the OVID interface.
[(exp cornea OR exp eye injuries OR corneal abrasion.mp) AND (exp mydriatics or cycloplegics.mp OR exp cyclopentolate OR cyclopentolate.mp OR exp atropine OR homatropine.mp OR exp tropicamide OR tropicamide.mp)] LIMIT to human, english and abstracts.

Search Outcome

98 papers were found of which 97 were irrelevant or of insufficient quality. The remaining paper is shown in the table.

Relevant Paper(s)

Author, date and country	Patient group	Study type (level of evidence)	Outcomes	Key results	Study Weaknesses
Brahma AK et al, 1996, UK	401 patients with corneal abrasion Lubrication alone vs 2% homatrapine (single dose) vs flubiprofen 0.03% QDS vs flubiprofen 0.03% QDS and homatropine stat	PRCT	Difference in pain score over 24 hour period and use of oral analgesia	No difference between homatrapine and simple lubrication. No difference between the 2 groups receiving flubriprofen.	Only 55% of patients followed up All patients also received chloramphenicol ointment Study not blinded

Comment(s)

The use of cycloplegics/mydriatics 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 owing to poor follow up and a number of compounding factors. However, even this study found no benefit to mydriatics (homatrapine 2%).

Clinical Bottom Line

Cycloplegics cannot be recommended for use in patients with corneal abrasion.

References

1. Brahma AK, Shah S, Hillier VF et al. Topical analgesia for superficial corneal injuries. J Accid Emerg Med 1996;13:186-8.