Safety and Effectiveness of Topical Anesthetics in Corneal Abrasions: Systematic Review and Meta-Analysis

Abstract

Background

Topical anesthetics are used in the emergency department (ED) to relieve eye pain and allow eye examinations in patients with corneal abrasions. There is concern for delayed corneal healing, which is associated with the long-term use of topical anesthetics, so outpatient use is not recommended.

Objectives

We sought to systematically study the effectiveness and complications associated with the short-term use of topical anesthetics (≤72 hours) in the management of patients presenting to EDs with corneal abrasions.

Methods

Four electronic databases were searched from inception of the database until April 2014. We included studies of patients >16 years of age who were using topical anesthetics for <72 hours. Postoperative cases were not included.

Results

A total of 140 patients (68 in the intervention group and 72 in the control group) from 2 randomized trials were included in the analysis. Comparing control patients who did not use topical anesthetics to study patients who did use topical anesthetics, this meta-analysis found no significant difference in pain scores (standardized mean difference −1.01 [95% confidence interval {CI} −2.39 to 0.38), corneal healing (OR 1.31 [95% CI 0.53–3.27), or persistent symptoms (OR 0.98 [95% CI 0.06–16.69). The 2 trials reported no adverse effects.

Conclusion

There were no differences regarding pain, persistent symptoms, or corneal healing when comparing short-term use of topical anesthetics to placebo in the treatment of corneal abrasion. Data on safety are sparse, and the use of this treatment is currently not supported by evidence.

Introduction

Corneal abrasions are one of the most common complaints presenting to primary care and emergency departments (EDs) in the United States and worldwide, and represent the leading cause of red eye in EDs 1, 2, 3, 4. Corneal abrasion is defined as a disruption of the epithelium covering the cornea, and it is commonly caused by minor trauma, foreign bodies, contact lens use, and flash burns (5).

Although corneal abrasion is in general a self-limited benign entity, it can be the cause of discomfort, pain, and distress among patients and can lead to work absenteeism 4, 6. Although common in EDs, there is considerable variation in the clinical management approaches to corneal abrasions, including the use of oral analgesic, cycloplegic, and topical nonsteroidal antiinflammatory drugs (7).

Topical anesthetics traditionally have been used for pain management of corneal abrasions while the patient is in the ED; its use for outpatient analgesia has been discouraged because of the concern of delayed corneal healing that has been shown with its long-term use (8). However, the evidence supporting these concerns is mostly out of date and based on case reports. At the same time, the short-term use of topical anesthetics (<72 hours) in the acute setting is debated (9). Available research about short-term use is derived from studies reporting no complications after use of local anesthetics after photorefractive keratectomy and after corneal abrasions managed in EDs 10, 11, 12, 13, 14.

Withholding what appears to be a potentially appropriate therapy for pain associated with corneal abrasion leads to the use of other analgesics that may be not as effective and may even have more complications (9). The objectives of this systematic review are to study the effectiveness and potential complications of the use of topical anesthetics in the management of patients presenting to EDs with corneal abrasions.