Article Text

Current management of corneal abrasions: evidence based practice?
  1. K SABRI,
  2. J C PANDIT,
  3. V T THALLER,
  4. N M EVANS
  1. Royal Eye Infirmary, Apsley Road, Plymouth PL4 6PL
  2. School of Mathematics and Statistics
  3. University of Plymouth
  4. Drake Circus, Plymouth PL4 8AA
  1. G R CROCKER
  1. Royal Eye Infirmary, Apsley Road, Plymouth PL4 6PL
  2. School of Mathematics and Statistics
  3. University of Plymouth
  4. Drake Circus, Plymouth PL4 8AA
  1. Dr K Sabri.

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Editor,—Corneal abrasions are often painful, sometimes disabling but usually self limiting. They form a common presenting problem in general and ophthalmic casualties.12 However, there is no scientifically proved, universally accepted best method of treating this condition. Here in Plymouth, we attempted to document the various methods used in the management of corneal abrasions (including iatrogenic cases) nationally. Therefore, a questionnaire postal survey of all the ophthalmic units in the UK (England, Wales, Scotland, and Northern Ireland) was carried out during February and March 1997. In total, out of 162 questionnaires sent out, 134 were received, representing a response rate of 83%. Only 22% of the respondents have an established departmental policy for the treatment of corneal abrasions. In three quarters of the non-policy holding majority, patient management decisions are made by doctors alone. Patients are most commonly treated with an immediate dose of topical antibiotic or antibiotic and cycloplegic followed by a course of topical antibiotic. Padding and patient follow up is practised some of the time by most units and all of the time by the remaining minority. There is no statistically significant difference (p>0.05) between the policy holders and non-policy holders in their management regimes. The traditional trio of topical antibiotic, cycloplegic, and padding is still the mainstay of corneal abrasion treatment among units nationwide. However, there is a lack of reproducible scientific evidence to support this treatment.34 Larger randomised trials looking at the efficacy of the different treatment options are needed. Based on the outcome of future research, national practice protocols may be formulated and put into practice. This could reduce wasteful expenditure on ineffective treatments and make patient review more selective thus reducing costs to patient and provider alike. Furthermore, with clear policies in place, the management of corneal abrasions can be restructured so that the nursing staff and perhaps general practitioners play an increasingly active role in the diagnosis, treatment, and follow up of patients.

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