Link: Patch Unnecessary for Corneal Abrasions

Patching corneal abrasions does not significantly improve healing time, pain, analgesic use, symptoms, complication rates, or effects on activities of daily living, according to a Cochrane Systematic Review published online July 26.

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Chris H. L. Lim, MD, from the Royal Melbourne Hospital in Australia, and colleagues evaluated the outcomes among patients who received a patch and those who did not. Although several clinical trials have indicated no benefit to patching corneal abrasions, many of the studies were poorly powered to reveal differences between patching and not patching. Past reviews have restricted the studies and databases analyzed or have been unclear about patient selection criteria. Dr Lim and coworkers included in their analysis randomized and quasi-randomized controlled clinical trials undertaken since the publication of past reviews.

The researchers consulted 11 databases, queried companies about results of clinical trials not yet published, considered citations in the reviewed reports, reviewed conference proceedings, and looked at unpublished reports. Healing after 24, 48, and 72 hours was the primary outcome, and measures of pain, quality of life, and adverse effects were secondary outcomes. The reviewers considered 12 trials representing 1080 participants from the United States, United Kingdom, Canada, Switzerland, and Brazil. The trials varied in the certainty of the evidence. Overall, evidence for improved or accelerated healing with eye patching was not compelling.

At 24 hours, patients who received patches were less likely to be healed than patients with corneal abrasion not receiving a patch (risk ratio [RR], 0.89; 95% confidence interval [CI], 0.79 - 1.00) in seven trials with a total of 531 patients. Healing was about equal with or without a patch at the 48-hour mark (RR, 0.97; 95% CI, 0.91 - 1.02) for six trials including 497 patients, and also about equal at 72 hours (RR, 1.01; 95% CI, 0.97 - 1.05) for four trials with 430 participants. Healing time was very slightly longer among patients whose abrasions were patched, with a mean difference of 0.14 days (95% CI 0-0.27 days longer) from patients without patches, for 6 trials with 642 patients. In addition, pain ratings were similar between people with eye patches and those without. Pain risk appeared greater in the treated group, but the confidence intervals were very wide (RR, 1.51; 95% CI, 0.86 - 2.65) in two trials including 193 patients. Analgesic use, symptoms (tearing, light sensitivity, blurred vision, and foreign body sensation), complication rates, and activities of daily living were similar in the two groups.

People without patches received more cycloplegics or antibiotics than the people with patches. Limitations of the analyzed studies include lack of blinding that might have led to reporting bias from participants, too few details in some studies to adequately assess efficacy, high dropout rates in some studies, and compliance assessment in only three of the studies. The authors conclude that "patching of the eye is not useful for the treatment of simple, traumatic corneal abrasions." However, they point out that the certainty of the evidence is low to moderate and call for more focused studies and examination of patching efficacy for large corneal abrasions.

Read the full article from Medscape.com

Dr. Dexter's Take

I'm sure that you've learned so far in optometry school that certain patients with corneal abrasions may benefit from a patch as part of their treatment plan. It was thought that patching an eye with an abrasion may promote faster healing due to the fact that the lids are not allowed to interact with the damaged corneal tissue. A recent study done in Australia showed that patching an eye with a corneal abrasion is actually unnecessary. The study concluded that "Patching corneal abrasions does not significantly improve healing time, pain, analgesic use, symptoms, complication rates, or effects on activities of daily living." Apparently all it does is just make the patient look and feel uncomfortable!