Management of ocular trauma in emergency (MOTE) trial: A pilot randomized double-blinded trial comparing topical amethocaine with saline in the outpatient management of corneal trauma

Abstract

Background:It is unclear whether local anesthetic eye drops can be safely used for the topical anesthesia of patients with minor corneal injury who are discharged from the emergency department (ED).Objectives:To assess whether topical 0.4% amethocaine self-administered to a maximum recommended frequency of once every hour for 36–48 h is safe in the management of uncomplicated corneal injury in patients discharged from the ED.Patients and Methods:A pilot randomized double-blinded trial comparing topical 0.4% amethocaine with topical normal saline.Results:Forty-seven subjects were recruited, with 22 randomized to receive amethocaine and 25 to receive placebo (normal saline). Baseline characteristics, including corneal injury type, were similar in both groups. There were no significant functional or clinical adverse sequelae in the majority of enrolled patients who could be contacted at 2 weeks (17/22 for amethocaine and 21/25 for placebo). Follow-up for the primary study outcome was suboptimal, with only 7/22 from the amethocaine group and 9/25 from the saline group presenting for 36–48 h review; there was a statistically nonsignificant trend for persistence of the corneal defect in the amethocaine group as compared with the saline group (2/7 and 1/9, respectively).Conclusion:Compared with saline drops, amethocaine eye drops are not definitely safe but they are effective for topical analgesia in minor corneal injury. Until further definitive studies, topical nonsteroidal agents or long-lasting artificial tears may be preferred for the topical analgesia of minor corneal injury. Return for corneal re-evaluation will necessarily remain suboptimal in an otherwise self-limiting condition, leading to a bias even if study recruitment is good.

Perioperative Corneal Abrasion: Updated Guidelines for Prevention and Management

“…Ting et al 42 randomized 47 patients to receive either topical 0.4% amethocaine or placebo (saline), with follow-up at 36 to 48 hours. The treatment group had better pain control, and neither group had complications at the 2-week follow-up.…”

“…Concern for delayed reepithelialization derives from early animal studies [34][35][36] ; however, more recent laboratory and clinical investigations suggest that the effect of topical anesthetics on the corneal epithelium is insignificant. [37][38][39][40][41][42][43] Verma and colleagues conducted two randomized clinical trials 40,41 testing the safety and efficacy of topical anesthetics in controlling pain after surgically creating an epithelial defect during photorefractive keratectomy. In the first study, patients instilled drops of either 1% tetracaine hydrochloride or placebo (physiologic saline) every 30 minutes while awake for 24 hours after surgery.…”

Topical chloramphenicol prophylaxis is of dubious benefit in corneal abrasion

“…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 . Furthermore, the MOTE Trial, an ED‐based clinical trial of topical anaesthesia to treat corneal injury found no secondary infection at 48 h and 2 weeks in adults who were neither prescribed nor used topical antimicrobial chemoprophylaxis during the study period 4 . Chemoprophylaxis has only been reported to be effective for ocular trauma in high‐risk rural settings in less developed countries 5 …”

“…3 Furthermore, the MOTE Trial, an ED-based clinical trial of topical anaesthesia to treat corneal injury found no secondary infection at 48 h and 2 weeks in adults who were neither prescribed nor used topical antimicrobial chemoprophylaxis during the study period. 4 Chemoprophylaxis has only been reported to be effective for ocular trauma in high-risk rural settings in less developed countries. 5 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.…”

Contact lenses as a drug delivery device for epidermal growth factor in the treatment of ocular wounds

“…Strategies for wound healing of corneal tissue include topical application of artificial tears, antibiotics, anaesthetics, cyclosporine, corticosteroids, newer anti‐inflammatory drugs, growth factors or combinations of these therapies 8,11–18 . Other agents, such as antimicrobial peptides, 19 have also been suggested.…”