Patching for corneal abrasion

Abstract

Recent audits show that corneal abrasion is a common presenting eye complaint. Eye patches are often recommended for treating corneal abrasions despite the lack of evidence for their use. This systematic review was conducted to determine the effects of the eye patch when used to treat corneal abrasions. The objective of this review was to test the hypothesis that patching an eye following a corneal abrasion improves healing or provides pain relief. We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (which contains the Cochrane Eyes and Vision Group Trials Register) in The Cochrane Library (2007, Issue 4), MEDLINE (1966 to December 2007), EMBASE (1980 to December 2007), LILACS (3 December 2007), NRR (2007, Issue 4) and SIGLE (December 2004). There were no language or date restrictions in the searches. We also searched the reference lists of included studies, unpublished 'grey' literature and conference proceedings and contacted pharmaceutical companies for details of unpublished trials. We included randomised and quasi‐randomised controlled trials that compared patching the eye with no patching to treat simple corneal abrasions. Two authors independently assessed trial quality and extracted data. We contacted investigators for further information regarding quality of trials. The primary outcome was healing of the corneal epithelium and secondary outcomes were related to pain. Eleven trials, which randomised a total of 1014 participants, were included in the review. Meta‐analysis of seven studies with dichotomous healing outcomes favoured no patching on the first day of healing (risk ratio (RR) 0.89, 95% Confidence Interval (CI) 0.79 to 0.99). For days two and three there was no significant difference between the two groups. Of the nine trials that measured pain scores two favoured no patching and none favoured patching. Complication rates were low and no differences were noted in these between the two groups. No‐patch groups generally received more adjuvant treatment with antibiotics and/or cycloplegics than the patch group which is an important confounding factor. Treating simple corneal abrasions with a patch does not improve healing rates on the first day post‐injury and does not reduce pain. In addition, use of patches results in a loss of binocular vision. Therefore it is recommended that patches should not be used for simple corneal abrasions. Further research should focus on large (greater than 10 mm²) abrasions. 眼罩使用於角膜磨損 最近的審查顯示角膜磨損是一項目前常見的眼睛的抱怨。雖然缺乏證據，治療角膜磨損仍常建議使用眼罩。此系統性評論是要確認當角膜磨損時使用眼罩的效果。 此篇評論的目標是要試驗角膜磨損後使用眼罩可以改善瘉合或讓疼痛緩解的假設。 我們搜尋在Cochrane圖書館中(2007年，第4期)，登錄於Cochrane中心的控制性試驗(CENTRAL)(包括登錄於Cochrane的眼睛和視力的試驗)、MEDLINE (1966年到2007年12月)、EMBASE (1980年到2007年12月)、LILACS (2007年12月3日)、NRR (2007年，第4期)及SIGLE (2004年12月)。在搜尋中沒有語言或日期的限制。我們也搜尋納入研究的文獻目錄，未發表的 ‘灰色’ 的文獻和會議記錄及接觸藥學公司，取得詳細未發表的試驗。 包括比較使用和沒有使用眼罩處理單純角膜磨損的隨機和類隨機控制試驗。 兩位作者獨立的評估試驗品質及摘取資料。我們為了有關試驗品質的進一步的訊息接觸調查者。主要的結果是角膜表皮的癒合，及次要結果是疼痛相關的訊息。 此篇評論納入7篇隨機試驗，總共1014位參與者。7篇二分癒合結果的統合分析，不支持在癒合的第一天使用眼罩(risk ratio (RR) 0.89, 95% Confidence Interval (CI) 0.79 to 0.99)。在兩組之間，第2和第3天沒有顯著的不同。9篇試驗測量疼痛分數，2篇支援不要使用眼罩及沒有一篇支援使用眼罩。合併症在兩組之間的比率是低且沒有差異。沒有使用眼罩的組別通常比接受眼罩的組別，接受抗生素和/或睫狀肌麻痺劑等較多的輔助治療，這是一個重要的干擾因素。 以眼罩處理單純的角膜磨損，在損傷後第一天不會改善瘉合率，及不會降低疼痛。除此之外，使用眼罩的結果導致雙眼的視力喪失。因此建議單純的角膜磨損不應該使用眼罩。更進一步的研究重點應該在大的(比10 mm更大的)磨損。 本摘要由高雄榮民總醫院林麗英翻譯。 此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌。 由於創傷或異物造成單純角膜磨損後使用眼罩。角膜是眼睛的透明的外層。角膜擦傷或表面的損傷是常見的問題且會非常的疼痛。常見的治療選擇是在眼睛上方放一個封閉的眼罩。此篇評論11篇隨機控制研究，發現在損傷後第一天使用眼罩會減慢癒合，及對疼痛程度沒有差異。進一步的研究重點應該在大的(比10 mm更大的)磨損。