ABC of eyes: Injury to the eye
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《英国医生杂志》
EDITOR—There was a typographical error in the last sentence under the heading corneal abrasions. The sentence should have read, "The patient can use an eye pad for a day or so if the abrasion is large" .
Although we agree with the several studies which report that pads do not give benefit in smaller abrasions, this is not the clinical impression for large abrasions. Kaiser et al randomised 223 patients to either no patch or a patch.1 All received antibiotics and mydriatics. In the large abrasions (> 10mm2), the unpatched group took 4.2 (SD 0.45) days to heal compared with 3.45 (SD 0.82) days for the patched group (P < 0.08). Therefore, for large corneal abrasions, padding is still appropriate.
Regarding cycloplegics, Carley and Carley found only one pertinent study, which they described as "flawed because of poor follow up and a number of compounding factors."2 Some patients have marked relief of abrasion pain with the use of cycloplegics.
Regarding topical antibiotics, secondary corneal infection is a rare but devastating consequence of a corneal abrasion. Therefore the use of antibiotics for abrasions is a very reasonable course of action. Nonsteroidal anti-inflammatory drugs can reduce pain, but there have been some anecdotal reports of significant corneal problems.3 Although topical anaesthetics do give profound relief of pain, we do not recommend that patients receive these agents to self medicate as the risks of an anaesthetic cornea are great, including corneal perforation.
We agree that orbital fractures are best managed in conjunction with a department for maxillofacial surgery. Most patients with orbital and significant zygomatic fractures are referred to maxillofacial departments. It is important that they are also assessed in ophthalmic departments to exclude eye injury.
Peng Tee Khaw, professor and consultant ophthalmic surgeon
Moorfields Eye Hospital and Institute of Ophthalmology, University College London, London p.khaw@ucl.ac.uk
Peter Shah, consultant
Birmingham and Midland Eye Centre, Birmingham
Andrew R Elkington, emeritus professor
University of Southampton, Southampton
Competing interests: PTK and PS have received support to speak at educational meetings for Pfizer, Allergan, Alcon, CibaVision, and Merck Sharpe and Dohme. PTK receives research support from Cambridge Antibody Technology, and PS from Pfizer.
References
Kaiser PK, 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.
Carley F, Carley S. Mydriatics in corneal abrasion. Emerg Med J 2001;18: 273.
Guidera AC; Luchs JI; Udell IJ. Keratitis, ulceration, and perforation associated with topical nonsteroidal anti-inflammatory drugs. Ophthalmology 2001;108: 936-44.
Although we agree with the several studies which report that pads do not give benefit in smaller abrasions, this is not the clinical impression for large abrasions. Kaiser et al randomised 223 patients to either no patch or a patch.1 All received antibiotics and mydriatics. In the large abrasions (> 10mm2), the unpatched group took 4.2 (SD 0.45) days to heal compared with 3.45 (SD 0.82) days for the patched group (P < 0.08). Therefore, for large corneal abrasions, padding is still appropriate.
Regarding cycloplegics, Carley and Carley found only one pertinent study, which they described as "flawed because of poor follow up and a number of compounding factors."2 Some patients have marked relief of abrasion pain with the use of cycloplegics.
Regarding topical antibiotics, secondary corneal infection is a rare but devastating consequence of a corneal abrasion. Therefore the use of antibiotics for abrasions is a very reasonable course of action. Nonsteroidal anti-inflammatory drugs can reduce pain, but there have been some anecdotal reports of significant corneal problems.3 Although topical anaesthetics do give profound relief of pain, we do not recommend that patients receive these agents to self medicate as the risks of an anaesthetic cornea are great, including corneal perforation.
We agree that orbital fractures are best managed in conjunction with a department for maxillofacial surgery. Most patients with orbital and significant zygomatic fractures are referred to maxillofacial departments. It is important that they are also assessed in ophthalmic departments to exclude eye injury.
Peng Tee Khaw, professor and consultant ophthalmic surgeon
Moorfields Eye Hospital and Institute of Ophthalmology, University College London, London p.khaw@ucl.ac.uk
Peter Shah, consultant
Birmingham and Midland Eye Centre, Birmingham
Andrew R Elkington, emeritus professor
University of Southampton, Southampton
Competing interests: PTK and PS have received support to speak at educational meetings for Pfizer, Allergan, Alcon, CibaVision, and Merck Sharpe and Dohme. PTK receives research support from Cambridge Antibody Technology, and PS from Pfizer.
References
Kaiser PK, 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.
Carley F, Carley S. Mydriatics in corneal abrasion. Emerg Med J 2001;18: 273.
Guidera AC; Luchs JI; Udell IJ. Keratitis, ulceration, and perforation associated with topical nonsteroidal anti-inflammatory drugs. Ophthalmology 2001;108: 936-44.