Is Homatropine 5% effective in reducing pain associated with corneal abrasion when compared with placebo? A randomized controlled trial

Abstract

We found no significant difference in pain score reductions between the two groups but some level of therapeutic benefit is not excluded.

Perioperative Corneal Abrasion: Updated Guidelines for Prevention and Management

“…Topical cycloplegics can relieve pain secondary to ciliary spasm from traumatic iritis; however, they do not appear beneficial in uncomplicated corneal abrasion. 56,57 Eye patching has been used to improve patient discomfort; however, clinical studies suggest no benefit [58][59][60][61][62][63][64] and potential harm [65][66][67] with patching. Turner and Rabiu 67 conducted a meta-analysis of 11 randomized and quasirandomized studies comparing patching and no patching.…”

Topical chloramphenicol prophylaxis is of dubious benefit in corneal abrasion

“…I read with interest the clinical trial comparing 5% homatropine with placebo eye drops in patients with corneal abrasion, which found no significant difference in pain reduction at up to 24 h after enrolment 1 . Meek et al .…”

“…Meek et al . used chloramphenicol ointment in all study participants presumably to reduce the risk of abrasion‐related corneal infection 1 . However, there is no proven benefit of topical antimicrobial chemoprophylaxis in reducing secondary infection in patients with corneal abrasions, 2 and topical fluoroquinolones could delay corneal epithelial healing after keratectomy 3 .…”

“…In view of the sparse evidence of benefit, as well as the inconvenience and additional cost of antimicrobial eye ointment or drops administration in minor corneal abrasion, I seek clarification for the use of topical chloramphenicol prophylaxis in Meek's study 1 . As all participants are to receive that chloramphenicol ointment, the study protocol implies prophylaxis to be the standard of care for the ED management for uncomplicated corneal abrasion.…”

“…As all participants are to receive that chloramphenicol ointment, the study protocol implies prophylaxis to be the standard of care for the ED management for uncomplicated corneal abrasion. The possibility remains that chloramphenicol ointment used in Meek's study 1 could interfere with ciliary absorption of homatropine, reducing the latter's intended therapeutic effect and minimizing analgesic difference discerned between the homatropine and placebo arms.…”