Efficacy of eye patching for traumatic corneal abrasions: a controlled clinical trial. Eye patch treatment for the pain of corneal abrasion. Management of corneal abrasion in children: a randomized clinical trial. The evaluation of eye patching in the treatment of traumatic corneal epithelial defects. No eye pad for corneal abrasion. Should we patch corneal erosions? The influence of excimer laser ablation on recurrent corneal erosions: a prospective randomized study. Efficacy of eyepad in corneal healing after corneal foreign body removal. The natural history and management of recurrent corneal erosion: a prospective randomised trial.
We sought to evaluate the efficacy of eye patching in the treatment of traumatic corneal abrasions in terms of time to healing and reduction in pain and discomfort.
                One hundred sixty-three patients presenting at the emergency department of a large university-affiliated hospital with traumatic corneal abrasions were included in this single-blind prospective controlled trial. Eligible patients were assigned to 1 of 2 treatment regimens: topical antibiotic ointment and occlusive patch over the affected eye (n=82) or topical antibiotic ointment 4 times a day without an occlusive patch (n=81). Patients were reexamined every 24 hours until corneal healing occurred. Healing evaluation was performed by the emergency physician, using a slit lamp with fluorescein staining, without knowledge of the patient's assignment to a treatment group. The degree of discomfort was assessed at each visit by using a visual analog scale.
                Both treatment groups were similar regarding size of the corneal lesions, delay from trauma to first ED visit, presence of foreign body or siderosis, initial degree of discomfort, and presence of specific symptoms (irritation, foreign body sensation, photophobia, redness, and pain). In the patched group, cumulative incidences of healing were 51%, 78%, and 92% after 1, 2, and 3 days, respectively, compared with 60%, 83%, and 88% in the nonpatched group. In the patched group, symptoms of initial discomfort decreased by 4.8, 4.1, and 5.5 cm after 1, 2, and 3 days, respectively, compared with 3.3, 5.1, and 6.5 cm in the nonpatched group.
                Eye patching does not appear to be beneficial in the treatment of traumatic corneal abrasions compared with topical antibiotic ointment. The traditional use of patching and topical antibiotics in the treatment of corneal abrasion has recently been challenged, particularly after foreign body removal. In a prospective, controlled, randomized study of 33 patients treated in the emergency department for eye pain and corneal abrasion, we attempted to determine whether eye patching affected the pain of simple corneal abrasions. After fluorescein examination with magnification (x 5), a visual analog pain score was recorded and the patient was randomized to either the patched or nonpatched group. A standard analgesic was supplied, and all patients had follow-up at 24 hours, when repeat pain scores and analgesic use were recorded. The groups were compared by using the Wilcoxon's rank sum test, Student's t test, and analysis of covariance as required. There was no significant difference in the mean changes in pain scores between the patched and nonpatched groups. Analgesic use was also similar. We conclude that routine eye patching does not favorably affect the pain associated with the treatment of simple corneal abrasion. We compare percentage of healing, comfort, and complications in children with corneal abrasions treated with an eye patch versus no eye patch.
                We performed a randomized clinical trial of patients aged 3 to 17 years who were diagnosed with isolated corneal abrasion. Patients were randomly assigned to an eye patch or no patch group. Abrasion size was documented with digital photographs and/or an eye template diagram at presentation and at 20- to 24-hour follow-up examination. A reviewer masked to treatment group determined percent healing by measuring presentation and follow-up abrasion sizes on the photographs/template. At follow-up, interference with activities of daily living (ADL) was measured with a visual analog scale and the number of pain medication doses taken since presentation was recorded.
                A total of 37 patients were enrolled: 17 with an eye patch and 18 with no eye patch. The mean patient age was 10 years, and two thirds of the patients were male. The majority (86%) of patients had 95% or more healing at follow-up, and there was no significant difference in percent healing between the 2 groups, even when adjusted for age and initial abrasion size (95% confidence interval [CI] for the difference in means -11 to 8 and -13 to 5, respectively). There was no difference between groups for number of pain medication doses required. Among measurements of interference with ADL, only the difficulty walking score was found to be significantly different between groups (patch mean 1.7 cm [SD 2.1 cm] versus no patch mean 0.3 cm [SD 0.7 cm]; 95% CI for the difference in means 0.3 to 2.5).
                This study suggests that eye patching in children with corneal abrasions makes no difference in the rate of healing. There was no difference in discomfort and interference with ADL, other than greater difficulty walking in the patch group, and there were no complications in either group. The objective of this study was to compare the rates of healing for patched and non-patched traumatic corneal epithelial defects (CEDs) after 1 day of treatment. To achieve this we initiated a randomized, controlled, prospective, clinical investigation comparing patching vs. non-patching of CEDs. Patients were evaluated initially and at 24 h using slit lamp biomicroscopy, and each corneal epithelial defect was documented on standardized initial and follow-up grid sheets. Percentage of healing and healing rates were determined by comparing the grid sheets. Our results found no significant difference in abrasion size between the two groups, but there was found to be a significantly improved rate of healing at follow-up in non-patched patients. This study demonstrates a significant improvement in the healing rate of traumatic CEDs in the non-patched group as compared to the patched group; therefore, the use of eye patching is not mandatory for corneal epithelial healing to occur. We have carried out a randomised clinical trial to assess the healing rate and level of discomfort experienced in two groups of patients with simple traumatic corneal abrasions. Patients treated with antibiotic ointment and mydriatic alone have a significantly improved healing rate compared with those treated with antibiotic ointment, mydriatic and a double eye pad with bandage (0.05 > p > 0.02). There was no significant difference in the level of discomfort experienced by the two groups. To study the effect of patching on the speed of reepithelialization, slit-lamp signs of epithelial wound healing, and patient discomfort following a corneal abrasion.
                Forty-eight eyes of 46 patients with corneal erosion sparing Bowman membrane were randomized into 2 groups: with or without patching. Slit-lamp examination and photographs of the fluorescein-stained cornea were performed on a daily basis until reepithelialization was complete. Photographs were analyzed using computer-assisted planimetry.
                No statistically significant difference was found between patched (n = 25) and nonpatched (n = 22) eyes for the mean size of the initial erosion (patched eyes, 23.7 mm2; nonpatched eyes, 18.9 mm2; P = .42), linear speed of reepithelialization (reduction over time of the radius of the largest circle included in the erosion: patched eyes, 0.0375 mm/h; nonpatched eyes, 0.0353 mm/h; P = .78), and surface speed of reepithelialization (reduction over time of the erosion area: patched eyes, 0.6510 mm2/h; nonpatched eyes, 0.5657 mm2/h; P = .60). The power to detect a 12-hour delay of epithelial closure was 95%. There were no significant differences between the 2 groups for pain, analgesia, insomnia, aspect of the epithelial border, intensity and duration of stromal edema, Descemet folds, anterior uveitis, and filaments.
                Patching a corneal erosion does not significantly accelerate reepithelialization and does not alter the epithelial wound healing pattern. It does not reduce the incidence and severity of inflammation nor relieve pain when compared with treatment without patching. We sought to evaluate the effect of excimer laser ablation on wound healing in patients with a history of recurrent corneal erosions.
                In a prospective, randomized study, 56 patients were treated either with epithelial removal only (n = 28) or epithelial removal followed by excimer laser ablation (n = 28). Patients were followed up at 1, 3, 6, and 12 months postoperatively. Visual acuity, refraction, intraocular eye pressure, and patients' symptoms, as well as their degree. were recorded before and after treatment. A recurrent erosion was regarded as a treatment failure. A Summit ExciMed 200 was used for the ablation. The laser was set to a 5-microm ablation by using a 6.5-mm in diameter treatment.
                With regard to ocular symptoms and recurrence of corneal erosions, treatment with excimer laser after epithelial removal was significantly better (p < 0.005) than epithelial removal alone on the healing of recurrent corneal erosions. No complications and no change in visual acuity, refraction, or intraocular pressure occurred.
                The use of excimer laser ablation after epithelial removal improved wound healing in patients with recurrent corneal erosions. 30 patients with corneal epithelial defect due to removal of corneal foreign bodies were randomly allocated to receive either chloramphenicol with continuous application of an eyepad or chloramphenicol without the eyepad. Almost all corneal defects were healed at 24 h, and all were healed by 48 h, with no statistically significant difference between the two groups. Discomfort at 24 h was greater in the eyepad group than in the control group. An eyepad seems to confer no benefit in healing and is uncomfortable. One hundred and seventeen patients with a history of recurrent corneal erosion were recruited at initial hospital presentation. Seventy-five cases had a history of shallow corneal injury, 23 had epithelial basement membrane dystrophy (EBMD), 8 had both and 11 had neither. Mean age at presentation was 38 years and follow-up ranged from 6 to 16 months (mean 10.6 months). Sixty-one patients presented with a first acute corneal erosion, 21 with a subsequent acute corneal erosion and 35 with chronic symptoms. Patients with EBMD or a trauma-related focal epithelial basement membrane abnormality were more likely to present with chronic recurrent symptoms than trauma-related cases with no abnormality on examination. Both EBMD and trauma-related cases typically recurred in the lower half of the cornea, frequently in the midline (z = 7.3, p < 0.0001), suggesting an intrinsic or acquired abnormality of the epithelial basement membrane at this site. Only four of 82 acute episodes did not resolve by 5 days with simple patching, cycloplegia and topical antibiotic ointment. In the vast majority of patients presenting with an acute erosion, simple management measures only are required. Of 117 cases started on prophylactic ointment at night, further therapy due to prophylaxis failure was required in only 5. EBMD was a risk factor for failure (relative risk 10.77). There was no difference in efficacy between once daily prophylactic paraffin and hypertonic saline ointments (p = 0.17), suggesting they both have only a lubricant action.
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.