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Editor,—We read with interest the comments by Sabri et al 1 on the many treatments used to manage acute corneal abrasions and the lack of any evidence based protocol. An evidence based approach requires that the natural history of the condition is well understood: a review of the literature shows a surprising lack of documentation regarding the clinical course of corneal abrasion after the initial injury has healed.2 Therefore, we present some of our observations of symptoms following uncomplicated traumatic corneal abrasion.
We prospectively followed 74 adults with traumatic corneal abrasion in previously healthy eyes. This was part of a study to assess whether the nightly use of lubricating ointment could reduce the incidence of recurrent corneal erosion. In 42 cases, the injury was caused by a fingernail. All patients were treated with a standard regimen of cyclopentolate 1% eye drops immediately and chloramphenicol four times daily for 5 days; eyepads were not used.2 3“Fingernail” injuries were randomised to receive either the standard treatment alone, or to continue with a topical lubricating ointment nightly for 2 months. Symptoms were assessed 3 months after the injury by a telephone questionnaire, and case notes were reviewed after 2 years.
We found a high prevalence of symptoms suggestive of recurrent corneal erosion at 3 months’ follow up. Twenty one patients (28%) reported frequent and significant pain, grittiness, photophobia, or watering of the injured eye only.4 Symptoms were relatively minor (did not interfere with daily activities) in 9/42 (21%) of “fingernail” and 3/32 (9%) of “non-fingernail” injuries. Symptoms were severe enough to interfere with daily activities, or to cause the patient to seek advice from their general practitioner or pharmacist in four (10%) fingernail and four (12%) non-fingernail injuries. By 2 years, two patients with fingernail injuries had presented with recurrent corneal macroform erosions,5 6 one at 3 months and the other after 7 months.
Our results illustrate that our understanding of this common condition is still very limited. A surprisingly high proportion of patients endure recurrent symptoms following traumatic corneal abrasion, but do not re-present to the ophthalmologist. This high prevalence of symptoms suggests that we should consider changing our initial treatment regimen. We suggest that any future evaluation of treatment for corneal abrasion should include long term follow up of patient symptoms.
Editor,—We thank Morrison and colleagues for their comments regarding the long term outcome of corneal abrasions. Our survey looked at the immediate treatment of corneal abrasions only. However, Morrison et almention that there have been no reproducible scientific studies looking at the natural history of corneal abrasions. The overwhelming conclusion from both Morrison’s and our studies is that further large scale, scientific research is needed in order to look at the most effective treatment regimens in terms of both immediate and long term outcome of corneal abrasions.