Use of Topical Anesthetics in the Management of Patients With Simple Corneal Abrasions: Consensus Guidelines From the American College of Emergency Physicians

Green, Steven M.; Tomaszewski, Christian; Valente, Jonathan H.; Lo, Bruce; Milne, Ken

doi:10.1016/j.annemergmed.2024.01.004

Cited by 2 publications

(4 citation statements)

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“…However, sidestepping concerns of the ophthalmologists regarding clinical recommendations, the emergency physicians of the group recently published guidelines without any ophthalmologist authors. 27 The guidelines endorse dispensing 1.5 to 2 mL topical anesthetics (q30 minutes for 24 hours) for corneal abrasions in the emergency department setting. 27 This amount (60–80 drops) actually would last 30–40 hours, although the guidelines state patients would be asked to discard drops after 24 hours.…”

Section: Discussionmentioning

confidence: 99%

“… 27 The guidelines endorse dispensing 1.5 to 2 mL topical anesthetics (q30 minutes for 24 hours) for corneal abrasions in the emergency department setting. 27 This amount (60–80 drops) actually would last 30–40 hours, although the guidelines state patients would be asked to discard drops after 24 hours. Guideline authors question the emphasis our Cochrane Systematic Review places on RCTs, question its relevance because it is “written solely” by ophthalmologists (not true), and claim an “existing practice pattern of ophthalmologists prescribing topical anesthetics for photorefractive keratectomy postoperative analgesia either for initial use or for breakthrough pain” (not accurate).…”

Section: Discussionmentioning

confidence: 99%

“…The lack of consensus guidelines may account for variations in practice within and across specialties. [25][26][27] The main objective of this summary of our Cochrane systematic review is to report the comparative effectiveness and safety of topical ophthalmic anesthetics compared with placebo or other treatments for corneal abrasions of any etiology, based on the best available evidence. 28 In nine eligible randomized controlled trials (RCTs) describing 556 participants with corneal abrasions from traumatic or surgical origin, we nd insu cient evidence to support outpatient use of topical ophthalmic anesthetics compared with placebo for reducing pain, improving re-epithelialization, or reducing complication risk in corneal abrasions.…”

Section: Introductionmentioning

confidence: 99%

“…The lack of consensus guidelines may account for variations in practice within and across specialties. 25 – 27 …”

Section: Introductionmentioning

confidence: 99%

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Topical Ophthalmic Anesthetics for Corneal Abrasions: Findings from a Cochrane Systematic Review and Meta-Analysis

Kuo,

Leslie,

Liu

2024

Preprint

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Background Despite potential benefit, outpatient use of topical ophthalmic anesthetics can result in poor healing, infection, scar, and blindness. An unbiased analysis of randomized controlled trials (RCTs) is needed to examine their effectiveness and safety compared with placebo or other treatments for corneal abrasions.Methods Cochrane Central Register of Controlled Trials, MEDLINE, Embase.com, Latin American and Caribbean Health Sciences, ClinicalTrials.gov, and the World Health Organization International Clinical Trials Registry Platform were searched on February 10, 2023, without restriction on language or publication date.Results Systematic review and meta-analysis of nine RCTs describing 314 participants with post-traumatic abrasions and 242 participants with post-surgical abrasions, with a median study length of 7 days (interquartile range, 7–14), show no evidence of a difference in pain control between anesthetics and placebo at 24 hours in post-trauma cases. Self-reported pain at 24 hours is reduced with anesthetics plus topical nonsteroid anti-inflammatory drug in post-surgical participants (mean difference [MD], -5.72 on a 10-point scale; 95% CI, -7.35 to -4.09; 1 RCT; 30 participants) and at 48 hours with anesthetics alone in post-trauma participants (MD, -5.68; 95% CI, -6.38 to -4.98; 1 RCT; 111 participants). Anesthetics are associated with 37% increased risk of non-healing defects (risk ratio, 1.37; 95% CI, 0.78 to 2.42; 3 RCTs; 221 post-trauma participants). All evidence is of very low certainty. Over 50% of trials have an overall high risk of bias.Conclusions Available evidence is insufficient to support outpatient use of topical anesthetics for corneal abrasions with respect to pain, re-epithelialization, and complication risk.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%