Topical NSAID’s Don’t Work Much for Corneal Abrasions

A review of studies on topical NSAID’s did not find strong reason to use. Agents included 0.1% indomethacin, 1% indomethacin, 0.03% flurbiprofen, 0.5% ketorolac, 0.1% diclofenac). The article was only an abstract; they grudgingly admitted used of oral painkillers might be less.

Emerg Med J. 2017 Dec;34(12):A868.
Topical nsaids for analgesia in traumatic corneal abrasions: a systematic
review and meta-analysis.
Lawrenson A et al
https://www.ncbi.nlm.nih.gov/pubmed/29170308

Cochrane analysis was exactly the same – said they were of little use but grudgingly had to admit oral painkiller use might be less

Wakai, Abel, et al.
Topical non‐steroidal anti‐inflammatory drugs for analgesia in traumatic corneal abrasions.
The Cochrane Library (2017)
http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD009781.pub2/full

In Canada, diclofenac 0.1% drops have gone generic and could be tried.

Other issues:

  • No point in patching – no difference
    Should we patch corneal abrasions? A meta-analysis.
    J Fam Pract.  1998; 47(4):264-70
    Flynn CA; D’Amico F; Smith G
    https://pdfs.semanticscholar.org/f6fc/46ab90a772a30bed3d06269051dfe53f25de.pdf
  • Mediscape suggests “contact lenses are at risk of pseudomonal infection and should receive antibiotics (eg, ciprofloxacin, gentamicin, or ofloxacin) accordingly. ” Otherwise little evidence for use of antibiotics and mediscape suggests if must use, use ” an ointment is preferred to drops as it acts a lubricant. Choices include erythromycin or sulfacetamide ointment 4 times daily for 3-5 days.
  • If abrasion is dirty, considers “trimethoprim/polymyxin B (Polytrim) or sulfacetamide sodium (Sulamyd, Bleph-10)”. If dirty contact lens issue, consider coverage for gram-negative organisms (especially pseudomonas) is recommended with agents such as gentamicin (Garamycin), tobramycin (Tobrex), norfloxacin (Chibroxin), or ciprofloxacin (Ciloxan).
    Emergency Care of Corneal Abrasion
    Medscape 2017
    https://emedicine.medscape.com/article/799316-overview#a3

Comment – main treatment is to watch closely for infection and give oral analgesics. Also, make sure there is no foreign body. I’ve got all these old eye patches – what am I going to do with them?

 

 

This entry was posted in eyes. Bookmark the permalink.

Leave a Reply

Your email address will not be published.