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184
Corneal abrasion
LISA CALDER
n Agents
n Topical NSAIDs
n Opioids
n Evidence
Based upon their widespread effective use and reported results from metaanalysis
of five RCTs, topical NSAIDs are the analgesic treatment of choice for
traumatic corneal abrasions (CAs). 1 Ketorolac 0.5% and indomethacin 0.1%
are the most studied agents, with significant efficacy compared with placebo.
2–7 Topical preparations of diclofenac (0.1%), flurbiprofen (0.03%), and
piroxicam (0.5%) also reduce CA pain. 8–12 The only noted adverse effect in
these studies of NSAIDs is transient (and minor) stinging. While data are
limited, topical NSAIDs are probably safe in children and can be considered
when no other alternatives are viable. 13
There are no studies on the use of oral or parenteral NSAIDs in CA.
However, there is intuitive basis for some benefit to their use, given the utility
of topically administered NSAIDs.
Opioids have not been directly assessed as analgesics for CA. Oxycodone
with acetaminophen (paracetamol) is useful as a rescue analgesic in patients
failing topical NSAIDs; the primary utility of the opioid in this setting may be
to aid in sleep. 11
The ophthalmology literature makes frequent reference to the analgesic
utility of bandage contact lenses in CA. 2,14,15 However, this approach is not
recommended for ED use since NSAIDs work well and the contact lens
approach is associated with potential infectious complications. 16
Eye patching, long advocated for its theorized effects on patient comfort,
lacks evidence basis for use in CA. A Cochrane review of nine RCTs addressing
patching and ocular pain found no studies favoring patching, with