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Report by Fiona Carley, Specialist Registrar Ophthalmology Search checked by Simon Carley Specialist Registrar
Clinical scenario
A 20 year old man presents to the emergency department with a history of something having blown into his eye. Clinical examination reveals a small abrasion to the cornea. You prescribe chloramphenicol ointment and discharge the patient. A friendly ophthalmologist suggests that you should have given a dilating drop as well. You wonder if there is any evidence to support this.
Three part question
[In patients with simple corneal abrasions] is [a cycloplegic better than simple lubrication] at [reducing pain and discomfort]?
Search strategy
Medline 1966–12/00 using the OVID interface. [(exp cornea OR exp eye injuries OR corneal abrasion.mp) AND (exp mydriatics OR cycloplegics.mp OR exp cyclopentolate ORcyclopentolate.mp OR exp atropine OR homatropine.mp OR exp tropicamide OR tropicamide.mp)] LIMIT to human, english AND abstracts.
Search outcome
Altogether 98 papers found of which 97 were irrelevant or of insufficient quality. The remaining paper is shown in table 4.
Comments
The use of cycloplegics/mydriatics is traditional and common practice for the treatment of corneal abrasions. However, there is no good evidence to support this. The only study pertinant to the three part question is flawed because of poor follow up and a number of compounding factors. However, even this study found no benefit to mydriatics (homatrapine 2%).
Clinical bottom line
Cycloplegics cannot be recommended for use in patients with corneal abrasion.
Report by Fiona Carley, Specialist Registrar Ophthalmology Search checked by Simon Carley Specialist Registrar