Abstract

Research Article

The evaluation of bandage soft contact lenses as a primary treatment for traumatic corneal abrasions

Hashim Thiab Hassan*

Published: 25 May, 2020 | Volume 4 - Issue 1 | Pages: 041-048.

Background: Corneal abrasions are a common result of eye trauma. Corneal injuries are very common in both the adult and pediatric population and account for a significant proportion of the workload of most emergency departments. Although abrasion heals well with preservative treatment, it still causes pain and job lost. The abrasion result from the scrabble of the corneal epithelium. These injuries cause pain, tearing, lids spasm, light scare, foreign body sensation, decreased visual acuity/blurring, and a gritty feeling. The light, friction & wink was worse the condition. Most abrasion cure within 24-27 hours and seldom proceed to erosion or infection. The study aims to use bandage soft contact lens [BSCL] as a primary treatment for traumatic corneal abrasion [TCA] instead of traditionally use pressure patch [PP].

Patients and methods: The present prospective study has been conducted on 50 patients attending the out-patient department of ophthalmology in an Alyarmouk teaching hospital for six months after taking ethical permission. Before subjecting the patient to the treatment of bandage soft contact lens therapy, a detailed clinical history and thorough local examination have been done. A history indicating the occurrence of recent ocular trauma followed by severe pain, redness, lids spasm, photophobia, and tearing of the involved eye is suggestive of a corneal abrasion. Always we ask about contact lens wear as this can complicate the presence of an abrasion. To confirm the diagnosis of traumatic corneal abrasion we examine the cornea by slit-lamp under cobalt-blue filtered light after the application of tetracaine eye drops & fluorescein strips. The treatment of 50 consecutive patients presenting with traumatic corneal abrasion has been treated with anesthetic eye drop (tetracaine 0.5%) to relieve pain and lids spasm, antibiotic eye drop (ofloxacin 0.3%), therapeutic bandage soft contact lens was applied to provide pain relief and once again act as a splint to promote epithelial healing, then visual acuity was measured by Snellen chart, a cycloplegic eye drop (cyclopentolate 1%) was applied to relieve ciliary spasm & then preservative-free lubricant eye drop were applied lastly. This criterion dramatically relieves most, if not all of the pain the patient may be experiencing (which is a big plus for the patient and earns instantaneous trust), but it also allows the patient to return to work/school or any other daily activities. Patients have been evaluated after 24hours, 72hours and after 1week regarding pain, visual acuity, and complications. Though pressure patch [PP] occasionally advice in abrasion therapy, it does not assist and may prevent recovery. Employ the protective eyewear can preclude the traumatic corneal abrasion.

Results: A total of 50 cases were enrolled in our study during the study period of 6 months. Out of 50 patients, there were 30males and 20 females and the male/female ratio was 3:2. The patient’s age was ranged from 5-35years. The commonest cause of injury was direct minor trauma (80% of cases), with cosmetic & optical contact lenses related problems accounting for 20% of presentations, visual acuity was documented correctly in 90% of adult and pediatric group and difficult to documented in children less than 6-year-old 10%. Traumatic corneal abrasion treated with bandage soft contact lens has an apparent advantage over the traditional pressure patch in terms of reduced pain, speedier healing, and an advantage of faster rehabilitation, facilitation epithelial healing, and proper surface hydration. Evaluation of pain revealed sufficient comfort with this regimen, allowing 45 patients (90%) to go back immediately to their occupations. Moreover, visual function is retained without any complication. Healing of the traumatic corneal abrasion occurred within 1 to 3 days in all patients, with minimal or no pain. The infection did not occur at the time of the follow up. We remove the bandage soft contact lens after 1 week to allow epithelial migration and attachment without the interference of the shearing forces of the upper lid.

Conclusion: The use of bandage soft contact lens as a primary treatment for a traumatic corneal abrasion is a safe and effective method with anesthetic eye drop (tetracaine 0.5%), antibiotic eye drop (ofloxacin 0. 3%), cycloplegic eye drop (cyclopentolate 1%), preservative-free lubricant drop instead of traditionally pressure patch. Bandage soft contact lens causes dramatic improvement from pain, lid spasm, tearing & visual function is retained without any complication, and patients can immediately resume their regular activities.

Read Full Article HTML DOI: 10.29328/journal.ijceo.1001032 Cite this Article Read Full Article PDF

Keywords:

TCA: Traumatic corneal abrasion; BSCL: Bandage Soft contact Lens; RCE: Recurrent Corneal Erosion; VA: Visual Acuity; PF: Preservative Free; ED: Eye Drop; PP: Pressure Patch

References

  1. Wilson SA, Last A. Management of Corneal Abrasions, University of Pittsburgh Medical Center St. Margaret Family Practice Residency Program, Pittsburgh, Pennsylvania. Am Fam Physician. 2004; 70: 123-128. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/15259527
  2. Verma A. Senior Consultant, Department of Ophthalmology, Dr. Daljit Singh Eye Hospital, India.
  3. Dua HS, Forrester JV. Clinical patterns of corneal epithelial wound healing. Am J Ophthalmol. 1987; 104: 481-489. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/3674182
  4. Wong TY, Lincoln A, Tielsch JM, Baker SP. The epidemiology of ocular injury in a major US automobile corporation. Eye (Lond). 1998; 12: 870-874. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/10070526
  5. Lai TY, Wong VW, Leung GM. Is ophthalmology evidence based? A clinical audit of the emergency unit of a regional eye hospital. Br J Ophthalmol. 2003; 87: 385–390. PubMed: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1771629/
  6. Wong TY, Lincoln A, Tielsch JM, Baker SP: The epidemiology of ocular injury in a major US automobile corporation. Eye (Lond). 1998; 12: 870–874. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/10070526
  7. Faheem A, HouseRJ, Hal FB. Corneal Abrasions and Corneal Foreign Bodies. Primary Care. 2015; 42: 363-375. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/26319343
  8. Myron Y. Ophthalmic Diagnosis & Treatment US automobile corporation. Eye (Lond). 1998; 12: 870–874.
  9. Lim CH, Turner A, Lim, BX. Patching for corneal abrasion. The Cochrane Database of Systematic Reviews. 26; 7: CD004764. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/27457359
  10. Mann I. Study of epithelial regeneration in living eye. Br J Ophthalmol. 1944; 28: 26 PubMed: https://www.ncbi.nlm.nih.gov/pubmed/18169982
  11. Dua HS, Gomes JA, Singh A. Corneal epithelial wound healing. Br J Ophthalmol. 1994; 78: 401-408. PubMed: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC504797/
  12. Acheson JF, Joseph J, Spalton DJ. From the Department of Ophthalmology, St Thomas's Hospital, London SE] 7EH, Use of soft contact lenses in an eye casualty department for the primary treatment of traumatic corneal abrasions.
  13. Flynn CA, D'Amico F, Smith G. Should we patch corneal abrasions? A meta-analysis. J Fam Pract. 1998; 47: 264-270. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/9789511
  14. Arrington GE. A history of ophthalmology. MD Publishers, New York. 1959.
  15. Weiner BM. Therapeutic bandage lenses. In: Silbert JA, ed. Anterior Segment Complications of Contact Lens Wear. Churchill Livingstone, New York. 1994; 455-471.
  16. Lima CA, Kara-Jose N, Nichols JJ. Indications, Contraindications, and Selection of Contact Lenses.
  17. . Witcherle O, Lim D. Hydrophilic gels for biologic use. Nature. 1960; 185: 117-118.
  18. Salz JJ, Reader AL 3rd, Schwartz LJ, Van Le K. Treatment of corneal abrasions with soft contact lenses and topical diclofenac. J Refract Corneal Surg, 1994; 10: 640–646. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/7719534
  19. . Christie CL. Therapeutic contact lenses. Cont Lens Anterior Eye, 1999; 22: S20–S25.
  20. Arora R, Jain S, Monga S, Narayanan R, Raina UK, et al. Efficacy of continuous wear PureVision contact lenses for therapeutic use. Contact Lens Anterior Eye. 2004; 27: 39–43. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/16303526
  21. Gilad E, Bahar I, Rotberg B, Weinberger D. A clinical study to evaluate therapeutic efficacy of soft contact lenses in corneal diseases.
  22. Punjabi S, Bedi N. Department of Ophthalmology, Geetanjali Medical College and Hospital, Udaipur, Rajasthan, India. A clinical study to evaluate therapeutic efficacy of soft contact lenses in corneal diseases.
  23. Buglisi JA, Knoop KJ, Levsky ME, Euwema M. Experience with Bandage Contact Lenses for the Treatment of Corneal Abrasions in a Combat Environment. Mil Med. 2007; 172: 411-413. https://www.ncbi.nlm.nih.gov/pubmed/17484314
  24. Menghini M, Knecht PB, Kaufmann C, Kovacs R, Watson SLet al. Department of Ophthalmology, University Hospital Zurich, Zurich, and b Eye Clinic, Lucerne Cantonal Hospital Lucerne, Switzerland; c Sydney Eye Hospital, Sydney, N. S. W., Australia Traumatic Corneal Abrasions: A Three-Arm, Prospective Randomized Study.
  25. .John G. McHenry, M. D. Bandage Contact Lenses.
  26. Brown N, Bron A. Recurrent erosion of the cornea. Br J Ophthalmol. 1976; 60: 84–96. PubMed: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1042677/
  27. Morrison R, Shovlin JP. A review of the use of bandage contact lenses. Metab Pediatr Ss'st Ophthalmol. 1982; 6: 117-121. PubMed:
  28. Dr Syed M Shahid Foundation Year 2 Trainee, University Hospital Lewisham, Mr Nigel Harrison, Consultant Emergency Medicine, University Hospital Lewisham, Corneal abrasion: assessment and management.
  29. Lewis R. Patch Unnecessary for Corneal Abrasions, August 03, 2016 Chris HL Lim, Angus Turner, Blanche X Lim, Patching for corneal abrasion, First published: 26 July 2016, Editorial Group: Cochrane Eyes and Vision Group.
  30. Turner A, Rabiu M. Patching for corneal abrasion Cochrane Database Syst Rev. 2006; CD004764. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/16625611
  31. Flynn CA, D'Amico F, Smith G. Should we patch corneal abrasions? A meta-analysis. J Fam Pract. 1998; 47: 264-270. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/9789511
  32. Donnenfeld ED, Selkin BA, Perry HD, Moadel K, Selkin GT, et al. Controlled evaluation of a bandage contact lens and a topical nonsteroidal anti-inflammatory drug in treating traumatic corneal abrasions. Ophthalmology. 1995; 102: 979-984. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/7777307
  33. Yanoff M, Fine BS. Ocular pathology. 2nd ed. Philadelphia: Harper and Row. 1982; 132-136.
  34. Hick G, Konen W, Klip. Lamellar or penetrating injuries of the cornea and their treatment by contact lenses. Fortschr Ophthaltnol. 1984; 91: 32-34.
  35. Arbour JD, Brunette I, Boiojolly HM, Shi ZH, Dumas J, et al. Should we patch corneal erosions? Arch Ophthalmol. 1997; 115: 313-17. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/9076201
  36. Salz JJ, Reader AL 3rd, Schwartz LJ, et al. Treatment of corneal abrasions with soft contact lenses and topical diclofenac. J Refract Corneal Surg. 1994; 10: 640-646. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/7719534
  37. Vandorselaer T, Youssfi H, Caspers-Valu LE, Dumont P, Vauthier L. Treatment of traumatic corneal abrasion with contact lens associated with topical nonsteroidal anti-inflammatory agent (NSAID) and anti-biotic: a safe, effective and comfortable solution. J Fr Ophtalmol. 2001; 24: 1025-1033. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/11913231
  38. Frucht-Pery J, Levinger S, Zauberman H. The effect of topical administration of indomethacin on symptoms in corneal scars and edema. Am J Ophthalmol. 1991; 112: 186-190. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/1543239
  39. Nelson LB, Wilson JW, Jeffers JB. Eye injuries in childhood: demographics, etiology, and prevention. Pediatrics. 1989; 84: 438-441. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/2771546
  40. Boberg-Ans G, Nissen KR. Comparison of Fucithalmic viscous eye drops and Chloramphenicol eye ointment as a single treatment in corneal abrasion. Acta Ophthalmol Scand. 1998; 76: 108—111. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/9541446
  41. Brahma AK, Shah S, Hillier VF, McLeod D, Sabala T, et al. Topical analgesia for superficial corneal injuries. J Accid Emerg Med. 1996; 13: 186—188. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/8733656
  42. Goyal R, Shankar J, Fone DL, Hughes DS. Randomised controlled trial of ketorolac in the management of corneal abrasions. Acta Ophthalmol Scand. 2001; 79: 177—179. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/11284758
  43. Kaiser PK, Pineda II R. A study of topical nonsteroidal anti-inflammatory drops and no pressure patching in the treatment of corneal abrasions. Corneal Abrasion Patching Study Group. Ophthalmology. 1997; 104: 1353—1359. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/9261326
  44. Frucht-Pery J, Levinger S, Zauberman H. The effect of topical administration of indomethacin on symptoms in corneal scars and edema. Am J Ophthalmol. 1991; 112: 186-190. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/1543239

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