The management of corneal abrasions in accident and emergency

Recent debate over the use of eyepads and mydriatics for corneal abrasions in ophthalmology departments (Mindin et al., 1996, JAMA 1996; 27: 837) has prompted this review of the management of small corneal abrasions (< 60% of cornea) in a large teaching hospital accident and emergency (A&E) department. Ninety-nine patients were studied who presented to the Leicester Royal Infirmary A&E Department with a corneal abrasion; 49 were given an eye pad and 50 were not given an eye pad. All patients received chloramphenicol (1%) ointment. There was no significance difference between the two groups in terms of the duration of pain (p > 0.2). Four patients developed corneal infections (two wore an eyepad, two had no eye pad). There was only one patient who suffered a transient but significant reduction in visual acuity (6/9-6/18), following the use of an eye pad and subsequent diagnosis in eye casualty of a dendritic ulcer. It is concluded that accident and emergency treatment of small corneal abrasions is safe and effective if an eye pad is not given. Previous criticisms of A&E management of eye problems (Nayeen and Stansfield, Archs Emerg Med, 1992; 9: 257) are unfounded in this department.