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Lack of consensus on corneal abrasion management: results of a national survey

Published online by Cambridge University Press:  21 May 2015

Lisa Calder ,
Sowmya Balasubramanian  and
Ian Stiell
Lisa Calder*
Affiliation:
Department of Emergency Medicine, University of Ottawa, Ottawa, Ont
Sowmya Balasubramanian
Affiliation:
Department of Emergency Medicine, University of Ottawa, Ottawa, Ont
Ian Stiell
Affiliation:
Department of Emergency Medicine, University of Ottawa, Ottawa, Ont
*
Department of Emergency Medicine, The Ottawa Hospital, Civic Campus, 1053 Carling Ave., Ottawa ON K1Y 4E9; 613 798-5555 x17484, [email protected]

Abstract:

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Objectives:

Our objective was to determine the practice patterns of Canadian emergency physicians with respect to the management of traumatic corneal abrasions.

Methods:

After developing our instrument and pilot testing it on a sample of emergency residents, we randomly surveyed 470 members of the Canadian Association of Emergency Physicians, using a modified Dillman technique. We distributed a pre-notification letter, an 18-item survey, and appropriate follow-up surveys to non-responders. Those members with an email address (n = 400) received a Web-based survey, and those without (n = 70) received a survey by post. The survey focused on the indications and utilization of analgesics (oral and topical), cycloplegics, eye patches and topical antibiotics.

Results:

Our response rate was 64% (301/470), and the median age of respondents was 38 years. Most (77.7%) were male, 71.8% were full-time emergency physicians, 76.5% were emergency medicine certified, and 64.4% practised in teaching hospitals. Pain management preferences (offered usually or always) included oral analgesics (82.1%), cycloplegics (65.1%) and topical nonsteroidal anti-inflammatory drugs (NSAIDs) (52.8%). Only 21.6% of respondents performed patching, and most (71.2%) prescribed topical antibiotics, particularly for contact lens wearers and patients with ocular foreign bodies. Two-thirds of the respondents provided tetanus toxoid if a foreign body was present, and 46.2% did so even if a foreign body was not present. Most respondents (88.0%) routinely arranged follow-up.

Conclusions:

This national survey of emergency physicians demonstrates a lack of consensus on the management of traumatic corneal abrasions. Further study is indicated to determine the optimal treatment, particularly regarding the use of topical NSAIDs.

Keywords

corneal abrasionsurveyemergency medicine
Type
Em Advances • Innovations en MU
Information
Canadian Journal of Emergency Medicine , Volume 6 , Issue 6 , November 2004 , pp. 402 - 407
Copyright
Copyright © Canadian Association of Emergency Physicians 2004

References

1.Le Sage, N, Verreault, R, Rochette, L.Efficacy of eye patching for traumatic corneal abrasions: a controlled clinical trial. Ann Emerg Med 2001;38(2):129–34.CrossRefGoogle ScholarPubMed
2.Eke, T, Morrison, DA, Austin, DJ.Recurrent symptoms following traumatic corneal abrasion: prevalence, severity, and the effect of a simple regimen of prophylaxis. Eye 1999;13(Pt 3a):345–7.Google Scholar
3.Kaiser, PK, Pineda, IR, An, B, Brun, S, Burk, S, Kim, R, et al. A study of topical nonsteroidal anti-inflammatory drops and no pressure patching in the treatment of corneal abrasions. Ophthalmology 1997;104(8):1353–9.CrossRefGoogle ScholarPubMed
4.Patrone, G, Sacca, SC, Macri, A, Rolando, M.Evaluation of the analgesic effect of 0.1% indomethacin solution on corneal abrasions. Ophthalmologica 1999;213(6):350–4.CrossRefGoogle ScholarPubMed
5.Jayamanne, DGR, Fitt, AWD, Andrews, RM, Mitchell, KW, Griffiths, PG.The effectiveness of topical diclofenac in relieving discomfort following traumatic corneal abrasions. Eye 1997;11:79–83.CrossRefGoogle ScholarPubMed
6.Alberti, MM, Bouat, CG, Allaire, CM, Trinquand, CJ; and the study group. Combined indomethacin/gentamicin eyedrops to reduce pain after traumatic corneal abrasion. Eur J Ophthalmol 2001;11:233–9.Google Scholar
7.Goyal, R, Shankar, J, Fone, DL, Hughes, DS.Randomised controlled trial of ketorolac in the management of corneal abrasions. Acta Ophthalmol Scand 2001;79:177–9.Google Scholar
8.Szucs, PA, Nashed, AH, Allegra, JR, Eskin, B.Safety and efficacy of diclofenac ophthalmic solution in the treatment of corneal abrasions. Ann Emerg Med 2000;35(2):131–7.CrossRefGoogle ScholarPubMed
9.Hulbert, MFG.Efficacy of eyepad in corneal healing after corneal foreign body removal. Lancet 1991;337:643.Google Scholar
10.Kirkpatrick, JNP, Hoh, HB, Cook, SD.No eye pad for corneal abrasion. Eye 1993;7:468–71.CrossRefGoogle ScholarPubMed
11.Patterson, J, Fetzer, D, Krall, J, Wright, E, Heller, M.Eye patch treatment for the pain of corneal abrasion. South Med J 1996;89(2):227–9.CrossRefGoogle ScholarPubMed
12.Kaiser, PK; the Corneal Abrasion Patching Study Group. A comparison of pressure patching versus no patching for corneal abrasions due to trauma or foreign body removal. Ophthalmology 1995;102:1936–42.Google Scholar
13.Campanile, TM, St. Clair, DA, Benaim, M.The evaluation of eye patching in the treatment of traumatic corneal epithelial defects. J Emerg Med 1997;15(6):769–74.CrossRefGoogle ScholarPubMed
14.Arbour, JD, Brunette, I, Boisjoly, HM, Shi, ZH, Dumas, J, Guertin, C.Should we patch corneal erosions? Arch Ophthalmol 1997;115:313–7.CrossRefGoogle ScholarPubMed
15.Michael, JG, Hug, D, Dowd, MD.Management of corneal abrasion in children: a randomized clinical trial. Ann Emerg Med 2002;40:67–72.CrossRefGoogle ScholarPubMed
16.Flynn, CA, D’Amico, F, Smith, G.Should we patch corneal abrasions? A meta-analysis. J Fam Pract 1998;47:264–70.Google ScholarPubMed
17.King, JWR, Brison, RJ.Do topical antibiotics help corneal epithelial trauma? Can Fam Physician 1993;39:2349–52.Google ScholarPubMed
18.Brahma, AK, Shah, S, Hillier, VF, McLeod, D, Sabala, T, Brown, A, et al. Topical analgesia for superficial corneal injuries. J Accid Emerg Med 1996;13(3):186–8.Google Scholar
19.Tintanalli, JE, Kelen, GD, Stapczynski, JS.Emergency medicine: a comprehensive study guide. 5th ed. New York: McGraw-Hill Companies Inc; 2000.Google Scholar
20.Marx, JA, Hockberger, RS, Walls, RM.Rosen’s emergency medicine: concepts and clinical practice. 5th ed. St. Louis (MO): Mosby Inc.; 2002.Google Scholar
21.Sabri, K, Pandit, JC, Thaller, VT, Evans, NM, Crocker, GR.National survey of corneal abrasion treatment. Eye 1998;12(Pt 2):278–81.CrossRefGoogle ScholarPubMed
22.Dillman, DA.Mail and telephone surveys: the total design method. Washington: John Wiley and Sons Inc; 1978.Google Scholar
23.Graham, ID, Stiell, IG, Laupacis, A, McAuley, L, Howell, M, Clancy, M, et al. Awareness and use of the Ottawa ankle and knee rules in 5 countries: Can publication alone be enough to change practice? Ann Emerg Med 2001;37(3):259–66.CrossRefGoogle ScholarPubMed
24.Hebert, PC, Wells, G, Martin, C, Tweeddale, M, Marshall, J, Blajchman, M, et al. A Canadian survey of transfusion practices in critically ill patients. Crit Care Med 1998;26(3):482–7.CrossRefGoogle ScholarPubMed
25.Cummings, SM, Savitz, LA, Konrad, TR.Reported rates to mailed physician questionnaires. Health Services Research 2001;35(6):1347–55.Google ScholarPubMed
26.Kruger, RA, Higgins, J, Rashford, S, Fitzgerald, B, Land, R.Emergency eye injuries. Aust Fam Physician 1990;19(6):934–8.Google Scholar
27.Morlet, N, Daniell, M.Empirical fluoroquinolone therapy is sufficient initial treatment. Br J Ophthalmol 2003;87:1167–9.CrossRefGoogle ScholarPubMed
28.Searl, SS.Minor trauma, disastrous results. Surv Ophthalmol 1987;31(5):337–42.CrossRefGoogle ScholarPubMed
29.Iyer, MN, Kranias, G, Daun, ME.Post-traumatic endophthalmitis involving Clostridium tetani and Bacillus spp. Am J Ophthalmol 2001;132(1):116–7.Google Scholar
30.Muddappa, TM, Rao, PN.Ocular tetanus. Indian J Ophthalmol 1982;30(3):163–5.Google ScholarPubMed
31.Benson, WH, Snyder, IS, Granus, V, Odom, VJ, Macsai, MS.Tetanus prophylaxis following ocular injuries. J Emerg Med 1993;11:677–83.Google Scholar
32.The Sowerby Center for Informatics, Department of Health, Government PRODIGY Guidance: practical support for clinical governance. Corneal Superficial Injury. Available: www.prodigy.nhs.uk/guidance.asp?gt=corneal%20superficial%20injury (accessed 2004 July 15).Google Scholar
33.Mahadevan, SV, Savitsky, E, Winograd, SM.Emergency management of traumatic eye injuries. Trauma Reports 2001;July:1. Available: www.emronline.com/trauma_archives.html (accessed 2004 Sept; authorization required).Google Scholar
34.Sheehan, KB, Grubbs Hoy, M.Using email to survey internet users in the United States: methodology and assessment. J Computer-Mediated Communication (JCMC) 1999;4(3):1–26. Available: www.sysurvey.com/tips/using_e-mail_to_survey.htm (accessed 2004 July 15).Google Scholar