Corneal Abrasions ================= þ Antibiotics do nothing for abrasions - We do it out of habit and because we're afraid not to do it and, besides, we have to do "something." ú Most rapid healing, least toxic: cefazolin sodium, Neosporin ú Slowest healing: tobramycin, gentamicin ú Worst cornea effect: tobramycin, gentamicin ú No significant difference between control solution and any active drop Stern GA, Schemmer GB, Farber RD, Gorovoy MS. Effect of topical antibiotic solutions on corneal epithelial wound healing. Arch Ophthalmol. 1983 Apr;101(4):644-7. Dollery W. Towards evidence based emergency medicine: best BETs from the Manchester Royal Infirmary. Antibiotics and corneal abrasion. J Accid Emerg Med. 1998 Sep;15(5):352. ú Sulfacetamide ($8 / 15cc) = Sulamydr = Bleph-10r ($21) ú Trimethoprim/polymyxin B ($14 / 10cc) = Polytrimr ($34 / 10cc) ú Tobramycin ($8) = Tobrexr ($35) ú Gentamicin ($10) = Garamycinr ($25) ú Norfloxacin = Chibroxin ($25) ú Ciprofloxacin = Ciloxanr ($41)= $8.20 per cc = $246 / oz = $1968 / coffee cup = $8200 / liter All costs are for 5 cc bottle unless otherwise stated --Joe Lex þ Extended-wear contact lenses - 75% of corneal ulcers from extended wear lenses are infected with Pseudomonas aeruginosa [Cohen EJ, Laibson PR, et al. Corneal ulcers associated with cosmetic extended wear soft contact lenses. Ophthalmology 1987;94:109.] - extended-wear lenses increase risk of keratitis 10x-15x. [Schein OD. Contact lens abrasions and the nonophthalmologist. Amer J Emerg Med 1993;11:606.] - patching for extended-wear lens abrasions is bad [Schein OD. Contact lens abrasions and the nonophthalmologist. Amer J Emerg Med 1993;11:606.] þ Patching does nothing for the pain of corneal abrasions. - [Patterson J, Fetzer D, Krall J, Wright E, Heller M. Eye patch treatment for the pain of corneal abrasion. South Med J 1996;89(2):227-9.] Abstract: [Hubert MFG. Efficacy of eyepad in corneal healing after corneal foreign body removal. Lancet 1991;337:643.] þ Patching slows down healing of corneal abrasions - [Kirkpatrick JN, Hoh HB, Cook SD. No eye pad for corneal abrasion. Eye 1993;7(Pt 3):468-71.] Abstract: - and makes the cornea more hypoxic: "In fact, clinical studies have been done which contend this and demonstrated the opposite, that patching reduces oxygen tension: Lowers partial pressure of oxygen in the corneal epithelium: [Weissman. Int Contact Lens Clin 1908; 5:41] demonstrated a marked drop in oxygen tension in the corneal epithelium under a patched/closed eye. 155mmHg open down to 55 mmHg eye shut. - as well as increasing pain. [Kaiser PK. A comparision of pressure patching versus no patching for corneal abrasions due to trauma or foreign body removal. Ophthalmology 1995;102:1936.] [Arbour JD, Brunette I, et al. Should we patch corneal erosions? Arch Ophthalmol 1997;115:313.] þ Patching itself can cause eye pain and corneal abrasions. [Frucht-Pery J, Stiebel H, Hemo I, Ever-Hadani P. Effect of eye patching on ocular surface. Am J Ophthalmol 1993;115(5):629-33.] Abstract: þ The Official "Don't Patch" - The Corneal Abrasion Patching Study Group says not to patch abrasions larger than 10 square mm (about 3 mm diameter). þ Topical anaesthetics delay healing of corneal abrasions - [Peyman GA, Rahimy MH, Fernandes ML. Effects of morphine on corneal sensitivity and epithelial wound healing: implications for topical ophthalmic analgesia. Br J Ophthalmol 1994;78(2):138-41.] Abstract: þ Topical NSAID drops help corneal abrasion pain, and probably don't delay healing appreciably. - [Donnenfeld ED; Selkin BA; Perry HD; Moadel K; Selkin GT; Cohen AJ; Sperber LT. Controlled evaluation of a bandage contact lens and a topical nonsteroidal anti-inflammatory drug in treating traumatic corneal abrasions. Ophthalmology 1995 Jun;102(6):979-84. (Lions Eye Bank for Long Island, North Shore University Hospital, Manhasset, NY)] Abstract: þ NSAID drops and "patch" contact lens for corneal abrasions 1. Torok PG, Mader TH. Corneal abrasions: Diagnosis and management. American Family Physician 1996;53:2521. 2. Wingate S. Treating corneal abrasions. The Nurse Practitioner 1999;24:53. 3. Cohen EJ, Laibson PR, et al. Corneal ulcers associated with cosmetic extended wear soft contact lenses. Ophthalmology 1987;94:109. 4. Imayasu M, Petroll WM, et al. The relation between contact lens oxygen transmissibility and binding of Pseudomonas aerzcginosa to the cornea after overnight wear. Ophthalmology 1994;101:371. 5. Schein OD. Contact lens abrasions and the nonophthalmologist. Amer J Emerg Med 1993;11:606. 6. Clemons CS, Cohen EJ, Arentsen JJ, et al. Pseudomonas ulcers following patching of corneal abrasions associated with contact lens wear. CLAD Journal 1987;13:161. 7. Hubert MFG. Efficacy of eyepad in corneal healing after corneal foreign body removal. Lancet 1991;337:643. 8. Patterson J, Fetzer D, et al. Eye patch treatment for the pain of corneal abrasion. South Med J 1996;89:227. 9. Kaiser PK. A comparision of pressure patching versus no patching for corneal abrasions due to trauma or foreign body removal. Ophthalmology 1995;102:1936. 10. Arbour JD, Brunette I, et al. Should we patch corneal erosions? Arch Ophthalmol 1997;115:313.