Pediatrics/Original Contribution
Management of corneal abrasion in children: A randomized clinical trial*,☆☆

Presented in poster form at the Society for Academic Emergency Medicine annual meeting, Atlanta, GA, May 2001.
https://doi.org/10.1067/mem.2002.124757Get rights and content

Abstract

Study objective: We compare percentage of healing, comfort, and complications in children with corneal abrasions treated with an eye patch versus no eye patch. Methods: We performed a randomized clinical trial of patients aged 3 to 17 years who were diagnosed with isolated corneal abrasion. Patients were randomly assigned to an eye patch or no patch group. Abrasion size was documented with digital photographs and/or an eye template diagram at presentation and at 20- to 24-hour follow-up examination. A reviewer masked to treatment group determined percent healing by measuring presentation and follow-up abrasion sizes on the photographs/template. At follow-up, interference with activities of daily living (ADL) was measured with a visual analog scale and the number of pain medication doses taken since presentation was recorded. Results: A total of 37 patients were enrolled: 17 with an eye patch and 18 with no eye patch. The mean patient age was 10 years, and two thirds of the patients were male. The majority (86%) of patients had 95% or more healing at follow-up, and there was no significant difference in percent healing between the 2 groups, even when adjusted for age and initial abrasion size (95% confidence interval [CI] for the difference in means −11 to 8 and −13 to 5, respectively). There was no difference between groups for number of pain medication doses required. Among measurements of interference with ADL, only the difficulty walking score was found to be significantly different between groups (patch mean 1.7 cm [SD 2.1 cm] versus no patch mean 0.3 cm [SD 0.7 cm]; 95% CI for the difference in means 0.3 to 2.5). Conclusion: This study suggests that eye patching in children with corneal abrasions makes no difference in the rate of healing. There was no difference in discomfort and interference with ADL, other than greater difficulty walking in the patch group, and there were no complications in either group. [Michael JG, Hug D, Dowd MD. Management of corneal abrasion in children: a randomized clinical trial. Ann Emerg Med. July 2002;40:67-72.]

Introduction

Corneal abrasion is one of the most common eye injuries presenting to the pediatric emergency department, comprising approximately half of all nonpenetrating anterior globe injuries.1, 2 The incidence of nonpenetrating injury to the globe (ie, laceration, hyphema, corneal abrasion) has been estimated at 15.7 per 100,000 persons per year,3 although no specific estimate for corneal abrasion could be found.

Current management of corneal abrasion in children is based on treatment established in adults. Recommended therapy consists of eye patching, cycloplegic drops, and antibiotics. It is thought that patching facilitates healing and relieves pain by decreasing eyelid shearing forces over the defect. Cycloplegic drops are believed to prevent discomfort from ciliary spasm, and antibiotics are used as infection prophylaxis.4, 5 Several studies in adult populations have concluded that eye patching does not speed healing or decrease pain. Other reasons cited against patching include loss of binocular vision, discomfort from the patch itself, reduced corneal oxygenation, reduced tear turnover, and increased risk of infection.6, 7, 8, 9, 10, 11, 12, 13, 14 Studies comparing patching versus not patching for corneal abrasion in children are lacking.

A randomized clinical trial was conducted to examine the difference in healing. Discomfort, doses of pain medication, and complications between those patched versus those not patched in children with corneal abrasions were also recorded.

Section snippets

Materials and methods

This study was conducted from July 1, 1999, to March 31, 2001, at an ED located in a children's hospital and evaluated patients from 3 to 17 years of age with the diagnosis of corneal abrasion. The lower age limit was chosen to facilitate slit lamp examination and pain assessment. Inclusion criteria included isolated corneal abrasion without other ocular trauma or any prior treatment and ability to return for a follow-up examination. Patients with erythromycin allergy; who did not speak

Results

Thirty-seven patients were enrolled in the study. Two patients randomized to the no patch group were not included in the data analysis, 1 with a retained foreign body under the eyelid causing new abrasions and 1 who was lost to follow-up. Of the 35 remaining patients, 17 were randomized to the patch group and 18 to the no patch group (Figure).

Figure. Study profile.

Twenty-two (63%) patients were male, and the mean age of all patients was 10 years. The majority of patients had no chronic illness

Discussion

In this group of pediatric patients, there was no difference in percent healing between the patch and no patch groups, even when adjusted for age and abrasion size, regardless of measurement technique used (photograph versus template drawing). Although initial sample size projections were not met for the main outcome, percent healing, the study did achieve 87% power to detect a 15% difference between treatment groups when post hoc sample size power was calculated using pediatric variability

Acknowledgements

We thank Steve Simon, PhD, statistical consultant, and the following physicians for their help with this study: Sarah Alander, MD; Theodore Barnett, MD; Laura Fitzmaurice, MD; Paul Johnson, MD; Tiffany Johnson, MD; Christopher Kennedy, MD; Jane F. Knapp, MD; Richard Marble, MD; Robert Schremmer, MD; Komol Desai, MD; John Lowery, MD; and Timothy Hug, OD.

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*

Supported in part by Katharine B. Richardson Grant Funding (Grant No. 01.4106).

☆☆

Address for reprints: Jeffrey G. Michael, DO, Division of Emergency Medicine, Children's Mercy Hospital, 2401 Gillham Road, Kansas City, MO 64104; 816 234-3663, fax 816 234-2039; E-mail [email protected]

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