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Editor,—We would like to expand on comments by Heyworth et al 1 regarding the use of topical lubricating ointment for prophylaxis of symptoms of recurrent corneal erosion.
The authors make the point that there are very few available data as to the prevalence of symptoms following traumatic corneal abrasion. We have addressed this specific issue in an ongoing prospective study. The study was designed to assess symptoms following uncomplicated traumatic corneal abrasion, and to assess the effect on symptoms of using a topical lubricant ointment. The project has the approval of our local research ethics committee.
All patients presenting with traumatic corneal abrasion in a previously healthy eye were treated with our standard regimen of cyclopentolate ointment 1% immediately and chloramphenicol eye drops four times daily for 5 days; eyepads were not used.2Injuries caused by a fingernail are felt to be at higher risk of progressing to recurrent corneal erosion,3 so these patients were randomised to one of two treatment groups. One group received our “standard regimen” alone, the other group continued with a “prophylactic regimen” of lubricating ointment4(Lacrilube, Allergan) at night for 2 months. Patients were followed up after 3 months by telephone, using a symptom based questionnaire. Recurrent symptoms were graded as: (i) none or minimal, (ii) mild, (iii) moderate (difficulty with some daily activities, or sought further advice from a health professional), and (iv) severe (macroform5 recurrent erosion). Case notes were reviewed at 2 years. Three year follow up, again by telephone questionnaire, is due to take place later this year.
Seventy four patients completed the 3 month follow up questionnaire (Table 1). Symptoms were considered to be due to recurrent corneal erosion if they were reported as frequent and significant pain, grittiness, photophobia, or watering3 of the injured eye only. A total of 21 patients (28%) reported such recurrent symptoms at 3 month follow up. We found no significant difference in symptom prevalence between “fingernail” and “non-fingernail” injuries which had been managed with our standard regimen (χ2test: p = 0.54). Treatment of fingernail injuries with additional nightly ointment was associated with a higher prevalence of symptoms at 3 months (significant to χ2 test, p = 0.016). Despite the high prevalence of symptoms in all groups at 3 months, only two patients had re-presented with macroform recurrent corneal erosion by 2 years. Both had been injured by a fingernail: one presented 3 months after treatment with our standard regimen, the other presented 7 months after a similar injury which was treated with additional nightly ointment.
These early results suggest that nightly lubricating ointment does not prevent recurrent symptoms when used following uncomplicated traumatic corneal abrasion. Instead, the reverse appears to be true, in that the group receiving additional ointment had significantly more symptoms at 3 month follow up. We were surprised at the high prevalence of recurrent symptoms in all groups. These early results imply that we should reconsider the place of both eyepad and ointment in our initial management. Future studies of treatment for corneal abrasion or erosion should pay close attention to patient symptoms.
Editor,—Eke et al have addressed the issue of symptoms following an acute traumatic abrasion and demonstrate that 28% of patients were still symptomatic 3 months after the event. In our discussion we suggest that what is required is a study examining the symptomatology of patients with established recurrent erosion syndrome before deciding what treatment modalities would be appropriate. Eke et al’s series represents a small group of patients (21) who are still symptomatic 3 months following an acute corneal abrasion, not long after the initial healing phase. This surely does not represent the group of patients that we are interested in—namely, those who have recurrent erosions some time following the initial injury. When Eke’s group report the results regarding symptomatology at 3 years (due later this year) this will better represent a group of patients with recurrent erosion syndrome albeit limited to a small subgroup of these patients with a traumatic aetiology and whose numbers may be considerably less than those reporting symptoms at 3 months.