Emergency management of corneal injuries

Corneal injuries account for a significant proportion of the ophthalmic workload of most emergency departments. Although the vast majority of cases are relatively minor, accurate diagnosis and appropriate management are vital to prevent potentially sight-threatening sequelae. We present a survey of corneal injury cases at a general emergency department.

Corneal injuries are very common in both the adult and paediatric population and account for a significant proportion of the workload of most emergency departments. This survey assesses management of corneal injury cases at a general emergency department.

A retrospective case study was performed of 100 patients consecutively diagnosed with a corneal abrasion by slit lamp examination at the emergency department of the Chelsea and Westminster Hospital, London. Each case was assessed to determine documentation of set criteria including visual acuity (VA), treatment and grade of examiner.

The commonest cause of injury was direct minor trauma (64% of cases) with contact lens related problems accounting for 12% of presentations. VA was documented correctly in 85 adult patients (90.4% of adults), incorrectly in 2 cases, and not documented at all in 7 adults (7.4%). VA was not recorded in paediatric cases. All cases were treated with topical chloramphenicol drops although frequency of treatment ranged from 2 to 5 times daily and duration of treatment ranged between 3 and 5 days and for 7 days. 6 cases (6%) were assessed by an emergency nurse practitioner and the remaining number were seen by a casualty officer.

VA must be accurately documented in all adult cases and should be documented in children of school age. A pinhole test should be performed in cases where VA is below 6/9. For analgesia, the use of topical nonsteroidal anti-inflammatory drugs, lubricants and bandage contact lens should be considered. Emergency nurse practitioners and general practitioners are ideally placed to follow-up uncomplicated cases.