Pediatrics/Original ContributionManagement of corneal abrasion in children: A randomized clinical trial*,☆☆
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).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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Cited by (0)
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Supported in part by Katharine B. Richardson Grant Funding (Grant No. 01.4106).
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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]