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Emerg Med J 20:62-64 doi:10.1136/emj.20.1.62-a
  • Best evidence topic reports

Tetanus prophylaxis in superficial corneal abrasions

  1. Prodeep Mukherjee, Specialist Registrar,
  2. A Sivakumar, Consultant,
  3. K Mackway-Jones
  1. Department of Emergency Medicine, Manchester Royal Infirmary, Oxford Road, Manchester M13 9WL, UK; kevin.mackway-jones{at}man.ac.uk

      Abstract

      A short cut review was carried out to establish whether tetanus prophylaxis is indicated after non-penetrating corneal abrasion. Altogether 30 papers were found using the reported search, of which one presented the best evidence to answer the clinical question. The author, date and country of publication, patient group studied, study type, relevant outcomes, results and study weaknesses of this best paper are tabulated. A clinical bottom line is stated.

      Report by Prodeep Mukherjee, Specialist Registrar
 Checked by A Sivakumar, Consultant

      Clinical scenario

      A 44 year old man presents to the emergency department with a foreign body sensation in his right eye. Fluorescein examination reveals a piece of grit. After removal there is a small corneal abrasion with no evidence of perforation. The patient has had a primary course of tetanus antitoxin and thinks his only tetanus booster was less than 10 years ago but is not sure. You wonder whether the patient requires a tetanus booster to reduce any risk from the abrasion.

      Three part question

      In [patients with non penetrating corneal abrasion] is [tetanus toxoid booster] necessary to [prevent clinical tetanus infection]?

      Search strategy

      Medline 1966–10/02 using the OVID interface. [(exp tetanus OR exp tetanus antitoxin OR exp tetanus toxin OR exp tetanus toxoid OR tetanus.mp) AND (exp Cornea OR corneal abrasion.mp OR exp Eye Injuries OR exp Eye Foreign Bodies OR exp Wounds, Nonpenetrating)].

      Search outcome

      Altogether 31 papers found of which 21 were irrelevant or of insufficient quality for inclusion. Five papers on cases of tetanus following penetrating eye injuries, one paper on tetanus from an eyelid injury, and three papers on treatment of ocular animal bite injuries were excluded as not directly relevant. The remaining paper is shown in table 3.

      Table 2
      Table 3

      Comment(s)

      The only relevant paper found was an experimental animal study. Unlike skin, corneal epithelium does not have an underlying blood supply (receiving nutrients from the aqueous humor) and often shows substantial healing within six hours of injury. Criteria for deciding if a corneal abrasion is tetanus prone or not should therefore probably be different than that for standard skin abrasions. Finally there are no case reports in the literature of clinical tetanus developing from a simple corneal abrasion. In clinical practice it should be remembered that there may be public health benefits in encouraging tetanus prophylaxis whenever the opportunity arises.

      ▸ CLINICAL BOTTOM LINE

      There is no clinical reason to provide tetanus prophylaxis in the emergency department following superficial corneal abrasions with no evidence of perforation, infection, or devitalised tissue.

      Report by Prodeep Mukherjee, Specialist Registrar
 Checked by A Sivakumar, Consultant

      References


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