[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.]
(Emergency Medicine Residency of the Lehigh Valley, Bethlehem, PA)
ABSTRACT: 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.

[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: BACKGROUND: Treating traumatic corneal abrasions is a common problem
for the ophthalmologist. Traditional management has been the use of a pressure
patch. Three different therapeutic modalities were evaluated for their
efficacy in treating traumatic corneal abrasions. METHODS: Forty-seven
consecutive patients with traumatic corneal abrasions were randomized
prospectively in a single-masked, controlled clinical trial which compared the
efficacy of (1) pressure patching, (2) a bandage contact lens, and (3) a
bandage contact lens with a topical nonsteroidal anti-inflammatory drug (0.5%
ketorolac tromethamine). RESULTS: There was no significant difference in the
healing time of the three groups. However, psychometric analysis showed a
significant decrease in pain in the group that received a bandage contact lens
with a topical nonsteroidal anti-inflammatory drug. There was a significant
difference in the ability to return to normal activities in both contact lens
groups compared with the pressure-patch group. There was no significant
difference among the three groups with respect to photophobia, redness, ocular
irritation, headache, or tearing. CONCLUSION: Use of a bandage contact lens
significantly shortens the time required for a patient to return to normal
activities. Moreover, addition of a nonsteroidal anti-inflammatory drug to a
treatment regimen significantly decreases the pain associated with traumatic
corneal abrasions. Use of a bandage contact lens with a topical nonsteroidal
anti-inflammatory may prove to be an effective adjunct in treating traumatic
corneal abrasions.

[Kirkpatrick JN, Hoh HB, Cook SD. No eye pad for corneal abrasion.
Eye 1993;7(Pt 3):468-71.]
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.

[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.]
Studies were conducted to examine the analgesic and toxic effects of topical
morphine on corneal abrasion. For the toxicity study, rabbits were
anaesthetized and epithelial cells were removed from the cornea and limbus.
Animals were randomised and treated topically as follows: (1) saline
(control); (2) morphine sulphate (MS, 0.5%); and (3) proxymetacaine
hydrochloride (proparacaine) (PH, 0.5%). Two drops of the solution were
instilled in the eyes at 4 hour intervals for 6 consecutive days and the
progression of corneal wound healing was assessed. Results showed that
repeated topical MS had no adverse effects on corneal wound closure. The
rates of wound healing were similar in both saline and MS treated groups.
Eyes treated with MS showed wound closure in a symmetrical fashion starting
on day 2 following abrasion. The progression of epithelial wound healing was
completed by day 4 in one eye, by day 5 in three eyes, and by day 7 in five
eyes. In contrast, repeated topical PH application delayed corneal wound
closure. Eyes treated with PH showed signs of corneal wound closure on the
third day, but only two eyes out of six had completed wound closure by the
eighth day after corneal abrasion. In a subsequent masked study, the
analgesic efficacy of topical MS was assessed in seven patients with
unilateral corneal abrasion. In all cases, a baseline response was first
established. Subsequently, saline was instilled in both eyes and the
patient's corneal response to pain pressure was determined 10 and 20 minutes
later. Finally, MS was applied and the analgesic effect on the cornea was
assessed.(ABSTRACT TRUNCATED AT 250 WORDS)

[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.]

We studied the effect of pressure patching in 27 medical students. Fourteen
students had pressure patching in one eye (group 1) and 13 (group 2) had light
patching. The fellow eye of each volunteer remained unpatched (group 3).
Clinical signs and symptoms were scored and evaluated at the first and the
following (after overnight) examinations. Before patching no subject had any
of the clinical signs or symptoms. After the patch was removed in groups 1 and
2, all except one volunteer in each group had clinical signs or symptoms, or
both, whereas in group 3, none had clinical signs or symptoms. Group 1 had
greater scores for clinical signs (P = .019) and for symptoms (P = .038) as
compared to group 2. In group 1, two participants did not complete the study
period (by removal of the patch) because of severe discomfort and three had
temporary irregularities in corneal surface with temporary decrease of vision.
We suggest that pressure patching may cause discomfort and changes in visual
acuity that are usually attributed to other reasons.