Risk Management
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Treatment of Corneal Abrasions
Dear Colleagues:
| OMIC wishes to bring to your attention an important discussion regarding treatment of simple corneal abrasions with topical anesthetic.The American College of Emergency Physicians (ACEP) recently published guidelines regarding the treatment of simple corneal abrasions, in which it concluded that “…for only simple corneal abrasions, as diagnosed and treated in accordance with the full protocol described herein, it appears safe to prescribe or otherwise provide a commercial topical anesthetic (i.e., proparacaine, tetracaine, oxybuprocaine) for use up to every 30 minutes as needed during the first 24 hours after presentation, as long as no more than 1.5 to 2 mL total (an expected 24-hour supply) is dispensed and any remainder is discarded after 24 hours.” [1]
In a response[2], the American Academy of Ophthalmology respectfully disagreed with the ACEP recommendations and conclusions, citing a lack of robust supporting data. It further noted that a 2023 Cochrane study on the use of topical anesthetics for corneal abrasion concluded that there was little evidence to predict the safety and efficacy of such treatment. In conclusion, the AAO opined that to insure patient safety, more rigorous scientific studies that include ophthalmologists are needed before guidelines can be issued. You may wish to consider the following treatment guidelines presented in a February 2024 EyeNet Cornea Clinical Update article, “Topical Anesthetics: The Latest on Use for Corneal Abrasions,” which offers a “three As” mnemonic device when treating corneal abrasions in the emergency department[3]:
We hope that this information will be helpful to you. Sincerely, Robert S. Gold Michael Tigani, MD Andrew Iwach, MD ______________________________ |
