Best Evidence Topics
  • Send this BET as an Email
  • Make a Comment on this BET

Topical non-steriodals reduce pain in corneal abrasions

Three Part Question

[In adults with acute corneal abrasions] are [non-steroidal eye drops better than simple lubrication] at [improving pain relief and improving time to healing.]

Clinical Scenario

A 25 year old man presents to the emergency department complaining of a 4 hour history of painful right eye after it was scratched by his 3 month old daughter. You recall being told that topical non-steroidal may be of help but wonder if they are any better than lubrication on its own. You also wonder if the non-steroidals may affect the eventual outcome and time to healing.

Search Strategy

Medline 1966-10/05 using the OVID interface.
Medline: ({[exp cornea OR cornea.ti,ab,rw,sh] AND abrasion$.ti,ab,rw,sh} AND [exp analgesia OR analgesi$.ti,ab,rw,sh OR exp anti-inflammatory agents, non-steroidal OR non-steroidal.ti,ab,rw,sh])
Pubmed: Corneal abrasions and NSAID's

Search Outcome

16 papers found of which 10 were relevant. However only the very recent high quality meta analysis of the other studies was used to update the original BET.

Relevant Paper(s)

Author, date and country Patient group Study type (level of evidence) Outcomes Key results Study Weaknesses
Brahma AK et al
401 patients with corneal abrasions in an eye emergency department. All patients received chloramphenicol ointment +/- study drops: polyvinyl alcohol alone, homatropine 2%, flubriprofen 0.03% or homatropine 2% + flubriprofen 0.03%PRCTOcular pain 6 hourlyBoth patient groups receiving flubriprofen had significantly less pain. There was no added benefit when homatropine was given with flubriprofen.Very low response rate, only 55.8% of patients enrolled in the study completed it.
Jayamanne DG et al
40 patients with unilateral traumatic corneal abrasions. All patients received chloramphenicol ointment +/- study drops: diclofenac sodium 0.1% or normal salinePRCTDay 2Less in diclofenac group (P < 0.001)
Ocular pain:
Day 1Less in diclofenac group (P < 0.02)
Kaiser PK and Pineda R
100 patients with traumatic or foreign body related corneal abrasions All patients received a cycloplegic and polymixin B +/- study drops: ketorolac tromethamine 0.5% or control vehicle dropsPRCTHealing timeNo difference
Complication rateNo difference
Foreign body sensationLess in ketorolac group from day 1 (P < 0.003)
PhotophobiaLess in ketorolac group from day 1 (P < 0.009)
Ocular painLess in ketorolac group from day 1 (P < 0.002)
Calder LA et al
459 patients with corneal abrasions in the emergency department or ophthalmology clinic receiving topical NSAID's +/- cointevention.Meta-analysisOcular pain score at 24 hours:Mean reduction in pain score by 1.30 points on the 0-10 pain scale (P < 0.00001).Variable level of quality of the 11 trials as well as the use of different pain scales and cointerventions. Possibility of publication bias.
Adverse effects of NSAID's:Insufficient data for a meta-analysis but transient stinging was noted as common adverse effect.


The trials all investigated different non-steroidal agents. No studies have been done to compare the relative merits of these drugs. Furthermore no trials comparing topical and oral preparations appear to have been done.

Editor Comment

This BET was originally submitted by Simon Carley (Consultant in Emergency Medicine) in June 2000. This BET was then updated by Mohammed Ziaei (Medical student) in August 2005.

Clinical Bottom Line

Non-steroidal anti-inflammatory agents are effective topical analgesics for traumatic corneal abrasions and do not appear to affect time to healing. However the lack of trials comparing oral and topical analgesia together with the cost of these preparations must be considered before these preparations are introduced.


  1. Brahma AK, Shah S, Hillier VF et al. Topical analgesia for superficial corneal injuries. J Acc Emerg Med 1996;13:186-188.
  2. Jayamanne DG, Fitt AW, Dayan M et al. The effectiveness of topical diclofenac in relieving discomfort following traumatic corneal abrasions. Eye 1997;79-83.
  3. Kaiser PK, Pineda R 2nd. A study of topical nonsteroidal anti-inflammatory drops and no pressure patching in the treatment of corneal abrasions. Opthalmology 1997;104:1353-1359.
  4. Calder LA, Balasubramanian S, Fergusson D. Topical nonsteroidal anti-inflammatory drugs for corneal abrasions: meta-analysis of randomized trials. Acad Emerg Med 2005; 12(5):467-73.