Evidence
Alert

Wearing a patch after a scratch to the eye probably makes no difference to healing

After a scratch or minor damage to the outer layer of the eye (corneal abrasion), wearing an eye patch is unlikely to reduce pain at 24 hours and might not lead to quicker healing after 24 hours. Patching the eye was compared to leaving the eye uncovered. Eye patches did not significantly affect symptoms such as eye watering, irritation, sensitivity to light or blurred vision.

Corneal abrasion is usually treated using ointments or drops to reduce irritation, pain killers, and antibiotic eye drops if there is a risk of infection. Eye patches are sometimes also used for short periods.

This Cochrane review found no compelling evidence that there was a difference in symptoms if patients used an eye patch or not. Because of the imprecision in the results it is not clear if more research would help settle the issue.

Patient preference and symptom relief remain important considerations when deciding whether or not to use an eye patch.

 

Why was this study needed?

Scratches to the surface of the eye – corneal abrasions – can occur due to fingernail scratches, contact lenses, branches or dirt getting caught under the eyelid and rubbing against the cornea. Corneal abrasions are a common reason for accident and emergencies departments visits, including specialist eye departments. Contusions or abrasions are found in about 44% of people presenting to emergency departments with painful eyes.

Treatment usually involves ointments or drops to relieve discomfort, painkillers such as paracetamol or ibuprofen to reduce pain, and antibiotic eye drops where there is a risk of infection. Often people are also given or ask for eye patches or a pad taped across their eye.

Despite being widely used, the evidence for the effectiveness of eye patches is less clear. Therefore this Cochrane review investigated whether eye patches were more effective than leaving the eye uncovered in terms of pain or the time it took to heal completely.

 

What did this study do?

This systematic review and meta-analysis compared the findings of 12 trials, including a total of 1,080 people, from North America, Europe and South America.

Most of the trials randomly allocated people to have an eye patch or not. Three studies used “quasi randomisation” where people were allocated based on either the order they arrived at the department or allocated differently on alternating days. This approach is not ideal as it can introduce a bias in the way people are randomised to a treatment.

Only one study was judged as having a low risk of bias in all aspects of study design. The other 11 studies had a mixed risk of bias, which affects our confidence in the combined findings.

 

What did it find?

  • After 24 hours people wearing an eye patch had the same chance of a healed cornea as people with no eye patch (risk ratio [RR] 0.89, 95% confidence interval [CI] 0.79 to 1.00, 531 people in 7 studies, graded low quality). At 48 and 72 hours there was no significant difference either.
  • There was no significant difference in the number of days until the abrasion was healed or how quickly the abrasion reduced in size between people wearing a patch or not.
  • No difference in pain was found at 24 hours, but the results were too imprecise for us to have confidence in this result.
  • There was little difference in symptoms such as watering eyes, sensitivity to light, irritation or blurred vision.

 

What does current guidance say on this issue?

The NICE Clinical Knowledge Summary recommends treating corneal abrasions using paracetamol or ibuprofen to relieve pain, or a single dose of a cycloplegic eye drop – a drug that stops eye spasms and resultant pain. Antibiotic eye drops can also be used to prevent infection. Eye patches are not mentioned in this guidance.

The College of Optometrists recommends not using eye patches for corneal abrasions (published 2015). This recommendation is based on the previous version of this Cochrane Review, published in 2006.

 

What are the implications?

This review suggests that patching the eye is probably not useful following a simple, traumatic corneal abrasion.

This review identified variations in the way that corneal abrasions are treated, and the imprecision in the results suggest we can’t be certain if future trials might overturn these findings.

Given that the clinical outcomes were similar, doctors treating corneal abrasion may want to incorporate patient preference and symptom relief into their decision-making. It is worth noting that there may be other reasons to patch an eye. Sometimes they are used following analgesic eye drops for example, when the blink reflex may be compromised.

 

Citation and Funding

Lim CH, Turner A, Lim BX. Patching for corneal abrasion. Cochrane Database Syst Rev. 2016;(7):CD004764.

Cochrane UK and the Eyes and vision Cochrane Review Group are supported by NIHR infrastructure funding.

 

Bibliography

CKS. Corneal superficial injury. London: Clinical Knowledge Summaries; 2012.

Turner A, M Rabiu. Patching for corneal abrasion. Cochrane Database Syst Rev. 2006;(2): CD004764.

Moorfields Eye Hospital NHS Foundation Trust. Patient information – accident and emergency service: corneal abrasion. London: Moorfields Eye Hospital NHS Foundation Trust; 2014.

NHS Choices. Eye injuries. London: Department of Health; 2016.

The College of Optometrists. Corneal abrasion. London: The College of Optometrists; 2015.

Produced by the University of Southampton and Bazian on behalf of NIHR through the NIHR Dissemination Centre

 

Commentaries

Expert commentary

Corneal abrasions are very common minor ocular injuries that can be exquisitely painful. Such abrasions may occur through a variety of accidents including in the workplace, sports injuries and daily activities and are common in children and patients within the working age group. Patients with corneal abrasions may present to a variety of health care professionals both in primary and secondary care settings. Health professionals are motivated to minimise pain and there is variation in practice with regards to patching the eye to improve comfort and with the intention to promote healing of the ocular surface.

Patients often request the eye to be padded to help alleviate their pain symptoms. This review should help healthcare professionals and their patients understand the distilled evidence that this practice may not be helpful for pain relief or for healing and minimise the use of unnecessary padding.

Miss Reshma Thampy, Consultant Ophthalmic Surgeon, Manchester Royal Eye Hospital