Cochrane Database of Systematic Reviews (Reviews) || Patching for corneal abrasion

Patching for corneal abrasion (Review)

Turner A, Rabiu M

This is a reprint of a Cochrane review, prepared and maintained by The Cochrane Collaboration and published in The Cochrane Library

2009, Issue 1

http://www.thecochranelibrary.com

Patching for corneal abrasion (Review)

Copyright © 2009 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.

http://www.thecochranelibrary.com

T A B L E O F C O N T E N T S

1HEADER . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

1ABSTRACT . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

2PLAIN LANGUAGE SUMMARY . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

2BACKGROUND . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

3OBJECTIVES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

3METHODS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

5RESULTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

8DISCUSSION . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

9AUTHORS’ CONCLUSIONS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

9ACKNOWLEDGEMENTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

9REFERENCES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

11CHARACTERISTICS OF STUDIES . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

22DATA AND ANALYSES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Analysis 1.1. Comparison 1 PATCHING VERSUS NO PATCHING, Outcome 1 Number healed on day 1. . . . 23



Analysis 1.4. Comparison 1 PATCHING VERSUS NO PATCHING, Outcome 4 Mean number of days to complete

healing. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25

Analysis 1.5. Comparison 1 PATCHING VERSUS NO PATCHING, Outcome 5 Sensitivity analysis - number healed on

day 1 in trials with masked outcome assessors. . . . . . . . . . . . . . . . . . . . . . . . 26

Analysis 1.6. Comparison 1 PATCHING VERSUS NO PATCHING, Outcome 6 Sensitivity analysis - number healed on

day 1 in trials that excluded foreign bodies. . . . . . . . . . . . . . . . . . . . . . . . . 26

Analysis 1.7. Comparison 1 PATCHING VERSUS NO PATCHING, Outcome 7 Sensitivity analysis - mean days to

healing in trials that included foreign bodies. . . . . . . . . . . . . . . . . . . . . . . . 27

27ADDITIONAL TABLES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

28APPENDICES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

30WHAT’S NEW . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

30HISTORY . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

31CONTRIBUTIONS OF AUTHORS . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

31DECLARATIONS OF INTEREST . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

31SOURCES OF SUPPORT . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

32INDEX TERMS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

iPatching for corneal abrasion (Review)


[Intervention Review]

Patching for corneal abrasion

Angus Turner1, Mansur Rabiu2

1Royal Victorian Eye and Ear Hospital, Victoria, Australia. 2National Blindness and Low Vision Survey Project, Kaduna, Nigeria

Contact address: Angus Turner, Royal Victorian Eye and Ear Hospital, 32 Gisborne St, East Melbourne, Victoria, 3002, Australia.

[email protected].

Editorial group: Cochrane Eyes and Vision Group.

Publication status and date: Edited (no change to conclusions), published in Issue 1, 2009.

Review content assessed as up-to-date: 2 December 2007.

Citation: Turner A, Rabiu M. Patching for corneal abrasion. Cochrane Database of Systematic Reviews 2006, Issue 2. Art. No.:

CD004764. DOI: 10.1002/14651858.CD004764.pub2.


A B S T R A C T

Background

Recent audits show that corneal abrasion is a common presenting eye complaint. Eye patches are often recommended for treating

corneal abrasions despite the lack of evidence for their use. This systematic review was conducted to determine the effects of the eye

patch when used to treat corneal abrasions.

Objectives

The objective of this review was to test the hypothesis that patching an eye following a corneal abrasion improves healing or provides

pain relief.

Search methods

We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (which contains the Cochrane Eyes and Vision Group

Trials Register) in The Cochrane Library (2007, Issue 4), MEDLINE (1966 to December 2007), EMBASE (1980 to December 2007),

LILACS (3 December 2007), NRR (2007, Issue 4) and SIGLE (December 2004). There were no language or date restrictions in the

searches. We also searched the reference lists of included studies, unpublished ’grey’ literature and conference proceedings and contacted

pharmaceutical companies for details of unpublished trials.

Selection criteria

We included randomised and quasi-randomised controlled trials that compared patching the eye with no patching to treat simple

corneal abrasions.

Data collection and analysis

Two authors independently assessed trial quality and extracted data. We contacted investigators for further information regarding

quality of trials. The primary outcome was healing of the corneal epithelium and secondary outcomes were related to pain.

Main results

Eleven trials, which randomised a total of 1014 participants, were included in the review. Meta-analysis of seven studies with dichotomous

healing outcomes favoured no patching on the first day of healing (risk ratio (RR) 0.89, 95% Confidence Interval (CI) 0.79 to 0.99).

For days two and three there was no significant difference between the two groups. Of the nine trials that measured pain scores two

favoured no patching and none favoured patching. Complication rates were low and no differences were noted in these between the

two groups. No-patch groups generally received more adjuvant treatment with antibiotics and/or cycloplegics than the patch group

which is an important confounding factor.

1Patching for corneal abrasion (Review)


mailto:[email protected]

Authors’ conclusions

Treating simple corneal abrasions with a patch does not improve healing rates on the first day post-injury and does not reduce pain. In

addition, use of patches results in a loss of binocular vision. Therefore it is recommended that patches should not be used for simple

corneal abrasions. Further research should focus on large (greater than 10 mm2) abrasions.

P L A I N L A N G U A G E S U M M A R Y

Patching the eye following a simple corneal abrasion caused by trauma or foreign body

The cornea is the transparent outer layer of the eye. Scratches or superficial damage to the cornea are common problems and are very

painful. A common treatment option has been to place an occluding patch over the eye. This review of 11 randomised controlled

studies found that the use of patches slows the healing on the first day after the injury and made no difference to pain levels. Further

research should focus on large (greater than 10 mm²) abrasions.

B A C K G R O U N D

Introduction

The cornea is the transparent outer layer of the eye. Although in a

highly exposed position it must present a tough physical barrier to

infection and trauma. It is composed of five layers, the outermost of

which is the corneal epithelium. Corneal abrasions are superficial

defects of the epithelium of the cornea. They are due mostly to

mechanical injuries to the cornea. Corneal abrasions are among

the most frequent ocular conditions encountered in eye emergency

departments (Lubeck 1988; Vaughan 1995). A recent audit ranked

corneal abrasions as the eighth most common condition diagnosed

in a series of 274 consecutive cases in the emergency department

of a regional eye hospital in Hong Kong (Lai 2003). In the same

audit external eye foreign bodies were the second most common

condition treated. Corneal foreign bodies are often associated with

corneal abrasions as, once removed, an epithelial defect remains.

Eye injuries lead to significant morbidity and lost productivity.

A major United States automotive corporation found an annual

incidence of 15 eye injuries per 1000 employees, with one third

of workers unable to resume normal duties for at least one day

(Wong 1998).

Corneal abrasions are also a common presenting condition in

general emergency departments. If one were to extrapolate the

findings of a British audit of general emergency departments

(Edwards 1987) and consider 3% of new admissions to be eye-

related trauma, then the total number of new cases of eye injuries

would be approximately 420,000 per year in England alone (DOH

2004). This number is based on the total number of presenta-

tions to accident and emergency departments in one year. In Eng-

land, there are a number of emergency departments specifically

for ophthalmology presentations where the proportion of corneal

abrasions and foreign body injuries is much higher (Lai 2003). In

addition general practitioners and optometrists would deal with a

large portion of the corneal abrasions and so one could infer that

this estimate of the total number of corneal abrasions in one year

is conservative.

Treatment options

Treating a corneal abrasion with a patch (some form of occlusion of

the affected eye) and use of topical antibiotics is the recommended

therapy for corneal abrasion in many references (Catalano 1992;

Cullom 1994; Khaw 2004; Parrish 1988; Pavan-Langston 1991;

Webster 1987).

Rationale for a systematic review

The practice of patching corneal abrasions has been questioned as

a number of trials on the topic have suggested no benefit (Hulbert

1991; Kirkpatrick 1993). Many of the trials have had small num-

bers and therefore have lacked the statistical power to demonstrate

any significant differences. A systematic review on the use of patch-

ing was completed in 1998 (Flynn 1998). This was reviewed by

the Centre for Reviews and Dissemination which identified sev-

eral areas for improvement: only one author assessed the validity

and quality of studies; the methods for selecting studies were not

stated; and eligible studies were restricted to those published in

English (CRD 2006). A second review, published in a Japanese

journal, was restricted to trials published in the English language

and the searches were restricted to only one database (Yamada



2001). Furthermore, there have been a number of new randomised

controlled trials on the topic published since these reviews were

prepared.

O B J E C T I V E S

The objective of this review was to test the hypothesis that patching

an eye following a corneal abrasion improves healing or provides

pain relief.

M E T H O D S

Criteria for considering studies for this review

Types of studies

This review included prospective randomised and quasi-ran-

domised controlled trials.

Types of participants

Participants in the trials were people of all ages with recent onset

(less than 48 hours) of corneal abrasion due to mechanical in-

jury or foreign body removal or contact lens use, as diagnosed by

fluorescein or slit-lamp examination. Trials of participants with

corneal abrasion due to infection, peripheral corneal degenerations

or chemical injury were excluded (these conditions can result in

epithelial loss similar to primary abrasions due to mechanical in-

juries, but the pattern, progression, treatment and prognosis dif-

fers markedly).

Types of interventions

The following comparisons were examined:

• eye patching versus no eye patching;

• eye patching with topical antibiotics versus no eye patching

with topical antibiotics.

Treatment may have included cycloplegics or analgesics or both.

Eye patching should have been for at least 24 hours continuous

intended use.

The following methods of eye patching were considered:

• cotton wool covered with a net held with tape over a closed

eye;

• pressure patching with either double eye pad or bulk gauze

(enough to exert pressure) on closed eye held with either bandage

or plaster. Tape or plaster placed onto the skin of the eyelids to

prevent eye opening;

• any other form of occlusion of the affected eye adopted by

the trialists.

Types of outcome measures

Primary outcomes

The primary outcomes for this review were:

• complete healing present or not present after 24 and 48

hours (dichotomous data);

• percentage/proportion healed after 24 and 48 hours;

• rate (proportion/length/area of epithelial defect recovered

per unit time).

Healing should have been ascertained using fluorescein staining

or slit-lamp examination.

Secondary outcomes

The secondary outcomes for this review were:

• pain assessment using 0 to 100 score, visual analogue score

or any form of pain measurement adopted by the trialists;

• visual outcomes using the visual acuity chart;

• use of analgesia;

• use of topical cycloplegics;

• measure of compliance to treatment;

• other symptoms, for example photophobia;

• quality of life measures;

• daily living activities assessments;

• insomnia assessments.

Adverse effects (severe, minor)

We examined the following adverse effects:

• infection or inflammation after commencement of trial as

diagnosed by trialists;

• recurrent corneal abrasions as diagnosed by repeated

episodes of corneal abrasion after complete healing had occurred;

• any other untoward events.

Follow up

The minimum length of follow up required was 24 hours after

enrolment. Follow up may have been repeated every 24 hours until

complete healing of abrasion had been noted.

Search methods for identification of studies

Electronic searches

We searched the Cochrane Central Register of Controlled Tri-

als (CENTRAL) (which contains the Cochrane Eyes and Vision



Group Trials Register) in The Cochrane Library, MEDLINE, EM-

BASE, Latin American and Caribbean Literature on Health Sci-

ences (LILACS), National Research Register (NRR) and System

for Information on Grey Literature in Europe (SIGLE). There

were no language or date restrictions in the search for trials. The

databases were last searched on 3 December 2007.

See: Appendices for details of search strategies for the above

databases.

The ISI Science Citation Index was searched in January 2004 us-

ing the identified studies as references. We also searched for ongo-

ing and prospective trials using the US ClinicalTrials.gov register

in January 2004. We used the Index to Scientific and Technical

Proceedings (from the Institute for Scientific Information access-

ing via BIDS) and Dissertation Abstracts (DA) to look for infor-

mation about unpublished trials.

Searching other resources

Additional handsearching focused on reference lists and abstracts/

proceedings of scientific meetings held on the subject. In particu-

lar, we searched the proceedings of the Association for Research in

Vision and Ophthalmology (ARVO). For the abstracts from 2002

electronic searches were performed using the key words: corneal

abrasion; patch*; occlusion; abrasion; trauma; foreign bod*. For

abstracts from 1993 to 2001 the ARVO proceedings index was

used searching through sections on ’Cornea’ and checking subsec-

tions of ’Wound healing’, ’Abrasion’, ’Epitheli*’.

We contacted the authors of relevant published studies to help

identify unpublished data. In March 2004 we contacted compa-

nies and pharmaceutical firms that produce eye patches and topi-

cal antibiotics (including GlaxoSmithKline, Pfizer, Alcon, Troge,

Sigma, Novartis, CibaVision) for unpublished data.

Data collection and analysis

Assessment of search results

Both authors, working independently, assessed the titles and ab-

stracts resulting from the searches. The full copy of all possibly or

definitely relevant studies were obtained for further assessment of

eligibility. We attempted to contact authors of articles where there

was insufficient information to determine their eligibility for the

review.

The criteria used to select studies and to assess their eligibility for

inclusion in this review were determined prior to searching. We

examined all published and unpublished trials that investigated

the use of patching as a treatment for corneal abrasions using the

following criteria.

• Study design: was the study randomised or quasi-

randomised?

• Participants: did the participants have a recent (less then 48

hours) corneal abrasion not related to infection or corneal

degeneration?

• Interventions: did one group get a form of eye patch/

occlusion? Did the comparison group receive similar care but

without wearing a form of eye patch?

• Outcomes: did the study measure the healing rate of

corneal abrasions?

• Follow up: were participants followed up for at least 24

hours after enrolment?

If any of the above questions rendered a negative response the

study was excluded. If the answer was unclear clarification with

the authors was sought.

Assessment of methodological quality

Both authors independently assessed the methodological quality

of each study. A component approach looking at individual qual-

ity domains was used for this review. We contacted investigators

for further information regarding quality of trials. The following

components were included.

• Randomisation: was the generation of allocation sequence

unpredictable?

• Selection bias (allocation concealment): was the sequence of

allocation of participants to groups concealed until after

treatments were allocated?

• Detection bias: were the persons assessing outcome unaware

of the assigned treatment?

• Attrition bias: were the rates of follow up similar in the

comparison groups? Was the analysis based on an ’intention-to-

treat’ principle?

A template was designed to assess each controlled trial and com-

ponents were graded as being either: A (adequate); B (unclear); C

(inadequate).

Data extraction

Both review authors worked independently to extract data as fol-

lows.

• Methods: method for assigning participants to patching

and control groups; masking of the outcome assessor; losses to

follow up; co-interventions; potential confounders.

• Participants: country; number of participants included and

excluded; exclusion and inclusion criteria; age; sex.

• Interventions: treatment (patching with description of

patching type) versus control (non-patching); duration of

treatment.

• Outcomes: number healed/not healed after 24, 48 and 72

hours; percentage/proportion of abrasions healed after 24, 48

and 72 hours; rate of healing measured in the proportion/surface

area of epithelial defect recovered over a time period and total

time to healing; pain scores; follow-up period.



Data synthesis

We used RevMan 4.2 software to analyse data. We combined the

results for days to healing and rate of healing in two meta-analyses.

We used the random-effects model. Summary measures for the

continuous outcomes were mean difference and if necessary stan-

dardised mean difference. We calculated risk ratios for dichoto-

mous data.

We performed sensitivity analyses to assess trials that had adequate

masking and trials that included only abrasions caused by the

removal of foreign bodies. We also considered the size of corneal

abrasions included in the trial to determine potential differences

between large and small abrasions. An arbitrary threshold for large

abrasions was chosen as those measuring more than 10 mm2.

R E S U L T S

Description of studies

See: Characteristics of included studies; Characteristics of excluded

studies.

Results of the search

The searches resulted in a total of 74 reports of trials. These were

screened and we retrieved 38 full text articles for further assess-

ment. Twelve papers described randomised controlled trials. One

further paper was a letter that contained enough information about

a new trial to include its results in the review (Rao 1994). One

study was subsequently excluded when translated since the two

groups in the trial had different types of patches applied and there

was no control group without patching (Gregersen 1991). An-

other randomised controlled trial was excluded as the character-

istics of the participants did not fit our selection criteria (Kurt

2003). Eleven papers were included in the review. The remaining

25 papers were either letters or comments made about trials that

had been conducted.

There were no current trials or prospective trials listed on the

UK and US online databases. The pharmaceutical firms were not

helpful in providing any unpublished trial information. A num-

ber of authors were able to provide further information regarding

their trials (Arbour 1997; Kaiser 1995; Kirkpatrick 2003; Le Sage

2001).

The characteristics of the 11 included studies are summarised

below. Details can be found in the ’Characteristics of included

studies.

An updated search was done in December 2007 which yielded

a further 75 reports of studies. The Trials Search Co-ordinator

scanned the search results and removed any references which were

not relevant to the scope of the review. The search did not identify

any references which met the inclusion criteria for the review.

Included studies

Setting and participants

The four earliest trials were conducted in the United Kingdom

(Hulbert 1991; Jackson 1960; Kirkpatrick 1993; Rao 1994). Four

further trials were conducted in the United States (Campanile

1997; Kaiser 1995; Michael 2002; Patterson 1996), two in Canada

(Arbour 1997; Le Sage 2001) and one in Brazil (Agostini 2004).

All of the participants had a recent, simple corneal abrasion. Three

trials excluded participants with a corneal abrasion secondary to

a corneal foreign body (Arbour 1997; Jackson 1960; Kirkpatrick

1993). Four trials included data on participants with corneal

abrasions specifically related to removal of corneal foreign bodies

(Agostini 2004; Hulbert 1991; Kaiser 1995; Le Sage 2001). The

total number of participants was 1014 with total post-randomisa-

tion exclusions of 183. One trial enrolled children (Michael 2002).

Interventions

All trials had two treatment groups with participants randomised

to receive a patch (a form of occlusion of the affected eye for 24

hours) or no patch. All trials included a form of concurrent med-

ication used in both treatment groups, for example antibiotic or

cycloplegic eye drops. These additional drops were mostly unequal

in their administration for the two groups, with the patch group

receiving one dose for 24 hours while the no-patch group may

have had three or four topical doses.

Types of outcome measures

Main outcomes

The primary outcome measure in all the trials was a measure of

corneal healing. Five trials measured the number of participants

who had completely healed (no further fluorescein staining) on

each day of follow up (Hulbert 1991; Jackson 1960; Kirkpatrick

1993; Le Sage 2001; Patterson 1996). Two trials measured mean

time to healing (Agostini 2004; Kaiser 1995). Two trials measured

percentage of healing on each day of follow up (Campanile 1997;

Michael 2002). Four trials measured corneal abrasion dimension

sizes at baseline and at each day of follow up (Arbour 1997;

Kirkpatrick 1993; Le Sage 2001; Rao 1994).

Other outcomes

Nine trials measured pain scores (Agostini 2004; Arbour 1997;

Hulbert 1991; Kaiser 1995; Kirkpatrick 1993; Le Sage 2001;

Michael 2002; Patterson 1996; Rao 1994). Some trials measured

analgesia use, compliance with treatment, activities of daily living,

other associated symptoms in the form of a questionnaire, and

dimensions of the abrasions.



Adverse events

Three trials specifically mentioned short-term adverse events

(Jackson 1960; Kaiser 1995; Michael 2002). Four trials reported

long-term complications and follow up two to seven months after

the corneal abrasion (Arbour 1997; Jackson 1960; Kaiser 1995;

Kirkpatrick 1993).

Economic measures

Economic measures were not evaluated in any trial.

Excluded studies

See: Characteristics of excluded studies for details.

Risk of bias in included studies

The overall quality of the included studies was poor (see Table 1

Quality Assessment Results). Only one trial, with a small number

of participants, received ’A’ ratings for all quality components (

Michael 2002). It appears that the quality of papers has improved

in recent trials. This may be due to improved reporting rather than

an improvement in the quality of the trials.

Selection bias

Although all the trials stated that they were randomised, most

failed to report on techniques used for randomisation. Three tri-

als received an ’adequate’ grading for randomisation (Kirkpatrick

1993; Michael 2002; Patterson 1996), two were ’inadequate’ due

to a quasi-randomised strategy of alternate days or cases being em-

ployed (Jackson 1960; Le Sage 2001). The remainder of the in-

cluded trials were ’unclear’. Of the four authors that replied to en-

quiries regarding the quality of their research (Arbour 1997; Kaiser

1995; Kirkpatrick 1993; Le Sage 2001) one was able to provide

information referring to a coin-tossing randomisation technique

that led to the grade for randomisation improving from ’unclear’

to ’adequate’ (Kirkpatrick 1993). The remaining authors could

not provide any additional information regarding quality compo-

nents of their trials.

Only one trial reported a method that results in unpredictable

assignment to the two treatment groups. Michael 2002 used block

randomisation with four participants in each block. Treatment

assignment was printed on a slip of paper and placed in envelope

packets, with each packet numbered and placed in order of block

assignment. It is not clear whether the envelopes used were opaque.

However, we gave the trial the benefit of the doubt and assumed

that this was the case. Thus, Michael 2002 received an ’A’ grade

for allocation concealment.

Detection bias

Four of the more recent trials reported masking of the outcomes

assessor (Arbour 1997; Campanile 1997; Le Sage 2001; Michael

2002). Three studies were graded ’unclear’ and four were graded

’inadequate’. In some of the ’adequate’ studies, outcomes assess-

ment involved a person with no knowledge of the treatment as-

signments viewing photographs or digital images of the corneal

abrasions. One study (Le Sage 2001) had participants remove the

eye patch 30 minutes prior to seeing the doctor who assessed the

outcome. Both methods used in these trials were deemed accept-

able forms of masking.

Attrition bias

Examining all the studies for attrition bias showed that losses to

follow up ranged from 0% to 34%. Most studies were unclear re-

garding the distribution of post-randomisation losses ie. whether

in the patch or the no-patch group. Even if they were evenly dis-

tributed, this was still not necessarily acceptable because one could

not assume that participants were lost from the groups for the

same reasons. It was possible that participants may have been lost

from one group for opposing reasons. For example, hypothetically

the patch may have caused pain so the participants removed the

patch and dropped out or were excluded from the study. Partici-

pants in the no-patch group may have felt no pain and, if healing

occurred quickly, had no further symptoms and felt that returning

for follow up was not necessary.

Trials also often reported exclusions of participants following ran-

domisation due to certain exclusion criteria, for example, some

participants were found to have residual foreign body or stain from

a prior visit on their first follow up visit so were excluded from

the study (Hulbert 1991). This may be a subjective judgement

and as the assessors were not masked to the treatment group, it

is possible that bias was introduced. The assessor may have noted

very poor healing in the no-patch group and also happened to note

some residual staining in the same participant, so found grounds

for exclusion. With the small numbers in this study, one or two

exclusions of this nature could significantly bias the results.

Only one trial mentioned using an intention-to-treat (ITT) anal-

ysis (Michael 2002). However, even in this trial those participants

lost to follow up were not included in the trial’s analyses as their

outcome data were not available and there was a post-randomisa-

tion exclusion for ineligibility. So in this case ITT referred to the

participants that were assigned to the ’patch’ group but removed

the patch during the period of follow up. They were still included

in the data analysis despite this deviation from the protocol. In-

tention-to-treat is important since it balances groups on known

and unknown prognostic factors. As ITT was not addressed ad-

equately in any of the studies, the results should be interpreted

with caution, especially given the large drop-out rates.

Effects of interventions



Primary outcomes

Healing day one

Seven trials reported data for the number of participants in each

group who had completely healed on the first day of follow up. The

P value for the test of statistical heterogeneity was high (P = 0.74)

indicating that it was reasonable to combine the results in a meta-

analysis. None of the studies individually showed any significant

difference between the two groups in the trial. When the data

were combined in a meta-analysis there was a greater number of

participants with complete healing on day one in the no-patch

group (risk ratio (RR) 0.89, 95% confidence interval (CI) 0.79

to 0.99) (see Analysis 1.1). However, if the two quasi-randomised

trials are excluded (Jackson 1960; Le Sage 2001) then the results

are no longer significant (RR 0.89, 95% CI 0.77 to 1.02).

Healing day two

Three trials reported data of complete healing of corneal abrasions

on day two of follow up. The RR was 0.94 but this was not

significant (95% CI 0.85 to 1.04) (see Analysis 1.2).

Healing day three

Two trials reported healing on day three. There was no difference

between the groups by this stage (RR 1.03, 95% CI 0.95 to 1.11).

Most of the corneal abrasions were healed regardless of which

treatment option was used (see Analysis 1.3).

Mean days to healing

Six studies had sufficient data to calculate the mean days to healing

of corneal abrasions and to determine a standard deviation. The

combined result showed no significant difference between patch-

ing and no-patching (mean difference (MD) 0.14, 95% CI 0.00

to 0.29) (see Analysis 1.4).

Secondary outcomes

Pain and discomfort was recorded in trials in a wide variety of

methods which made meta-analysis impossible. Means are also

not normally distributed for this outcome measure. Of the nine

trials that measured pain outcomes, only two reported significant

results with less pain in the no-patch group (Hulbert 1991; Kaiser

1995). Three other trials showed less pain in the no-patch groups

(Kirkpatrick 1993; Le Sage 2001; Michael 2002) and four demon-

strated less in the patch groups (Agostini 2004; Arbour 1997;

Patterson 1996; Rao 1994) but these were not signifcant.

Two trials reported mean pain scores according to visual analogue

scores on day one (Agostini 2004; Kaiser 1995). Kaiser 1995 found

that mean pain scores on day one were significantly higher in the

patch group (MD 0.95, 95% CI 0.39 to 1.31). Agostini found

similar pain scores in each group (MD -0.52, 95% CI -1.45 to

0.41). This result indicates that subjects scored less than 0 on

the pain scores which is not possible and attempts to clarify this

problem with the author were not successful.

Kirkpatrick 2003 reported the percentage decrease in pain scores

with a mean of 20.8% (20.3) in the patch group and 27.6 (24.2)

in the no-patch group.

Hulbert 1991reported the patch group as having more discomfort

at 24 hours (75% versus 29%) giving a risk ration of 7.5 (95% CI

1.17 to 55.6). Arbour 1997 presented the mean visual analogue

scores over all the days required until complete healing with a

mean in the patch group of 15.4 (SD 15.9) and a mean in the

no-patch group of 23.0 (SD 18.9) (P = 0.15). There were also no

differences in the percentage of participants reporting insomnia

due to the abrasion (36% in both groups). Analgesia was used by

84% in the patch group and 82% in the no-patch group. Despite

the results appearing to favour the patch group, 48% identified

the patch as their principal source of discomfort. Michael 2002

used pain scores with a picture scale of faces depicting different

levels of pain. Children in the patch group had a mean of 1.7

(SD 2.1) and 0.3 (SD 0.7) in the no-patch group. The 95% CI

for difference in means was 0.3 to 2.5. Patterson 1996 presented

24 hour mean pain scores without including individual data or

standard deviations. The patch group had a mean pain score 1.11

versus 2.47 in the no-patch group. The mean change in pain score

was 3.09 in the patch group and 2.77 in the no-patch group (P

= 0.50). Rao 1994 reported no significant differences in the pain

score between the groups on days 1 (P = 0.44) or 2 (P = 0.89).

Mean changes on a scale of 0 to 10 were 2.86 for day 1 and 1.65

for day 2 in the no-patch group and 3.18 for day 1 and 2.43 for

day 2 in the patch group. No standard deviations were reported.

Other secondary outcomes were included in many trials such as use

of analgesia, activity of daily living measures using visual analogues

scales (for example dressing, feeding, running, rest/sleep times),

patient compliance, presence of symptoms (photophobia, tearing,

foreign body sensation, blurred vision), use of mydriatic drops,

complications. None of these studies found a significant difference

between the two groups, with one exception. The study of children

used the activities of daily living scores and found that the patch

group had significantly greater difficulty walking (Michael 2002).

Subgroups

Michael 2002 enrolled children (3 to 17 year olds). This trial

showed no significant difference in healing of corneal abrasions

between the two groups. The outcome measure for healing was

not comparable to other studies so it was not included in the meta-

analysis for healing on day one.

Numbers of large abrasions (more than 10 mm2) were limited in

the trials. No trials specifically excluded participants with large

abrasions. Only one trial performed a subgroup analysis (Kaiser

1995). Even though this was one of the largest trials included in

this review, there still were not enough large abrasions to make the

subgroup analysis informative. There was no significant difference

demonstrated between no-patch and patch for the 16 participants

that were included in this category. This made up only 13% of

the total number of participants enrolled in the trial. The no-

patch group showed longer mean time to healing with 4.20 days

compared to the patched group with 3.45 days (P < 0.08).



Campanile 1997 had a smaller population than Kaiser 1995, with

64 cases in total. Individual data regarding abrasion size was re-

ported and the proportion of large abrasion was higher at 20%.

Nine of the thirteen large abrasions (more than 10 mm2) were

completely healed 24 hours after first presentation. Thirty nine of

51 small abrasions were completely healed over the same time pe-

riod. A t-test using data from the two groups of large abrasions in

the patch and no-patch groups demonstrated no significant differ-

ence (P > 0.6) as could be expected with small numbers included.

This subgroup cannot be combined in a meta-analysis with the re-

sults mentioned from Kaiser 1995 as different outcome measures

were used.

Sensitivity analysis

All trials that had adequate masking of the outcomes assessors

were included in a subgroup meta-analysis. The results favoured

no patch, however, 95% confidence intervals crossed the point of

null effect with a RR of 0.84 (95% CI 0.69 to 1.02) (Arbour 1997;

Campanile 1997; Le Sage 2001) (see Analysis 1.5).

A sensitivity analysis was performed looking at those studies that

contained dichotomous healing outcomes for day one and spec-

ified whether or not foreign bodies were included. Three studies

excluded foreign bodies (Arbour 1997; Jackson 1960; Kirkpatrick

2003). Not patching the eye was favoured but there was no signif-

icant difference in healing on day one (RR 0.87, 95% CI 0.68 to

1.12) (see Analysis 1.6). Similarly, for those studies that included

foreign bodies and had continuous outcome measures for healing

(Agostini 2004; Hulbert 1991; Kaiser 1995; Le Sage 2001) there

was no significant difference between the groups (WMD 0.12,

95% CI -0.05 to 0.30) (see Analysis 1.7).

D I S C U S S I O N

From the results of the meta-analyses, the no-patch groups had

significantly faster healing time on day one and no significant

differences in secondary outcomes such as pain scores. On days

two and three there were no statistically significant differences in

healing or pain scores between the two groups. It is, therefore,

reasonable to conclude that patching the eye is not useful for the

treatment of simple, traumatic corneal abrasions.

A random-effects rather than fixed-effect model was used in the

calculations to account for differences between the studies. Both

Jackson 1960 and Le Sage 2001 had inadequate methods of ran-

domisation. Only four studies had adequate masking of the out-

comes assessor. Kaiser 1995 used a different method of measuring

the outcome of healing. It was the only study that included both

subjective and objective assessments for the same healing outcome

ie. a pain score of less than or equal to two was considered sufficient

to indicate healing, as was only minor staining of the epithelium

upon instillation of fluorescein. Both of these outcome measures

were inadequate since they allowed for the introduction of bias.

The outcome assessor was not masked to treatment allocation and

was able to make a subjective judgement about the amount of

staining and whether a small amount of staining should be classi-

fied as healed or not. Similarly, a pain score of two could indicate

that the healing process is not complete as the person is still expe-

riencing discomfort (which normally indicates the presence of an

abrasion). There is no validation of the techniques used by Kaiser

1995 to determine complete healing.

Despite the low overall quality of the studies they demonstrated

a high level of clinical and statistical homogeneity. In addition,

all trials that reported the characteristics of the groups following

randomisation in terms of age, sex and pre-treatment measures

such as pain scores or size of abrasion, showed that the groups were

not significantly different to each other. Thus, it was reasonable

to include all the trials in the meta-analysis rather than excluding

studies on the basis of lower quality. It is worth noting, however,

that when the two quasi-randomised trials (Jackson 1960; Le Sage

2001) were excluded from the day one healing outcome, the results

were no longer significantly favouring no-patch groups.

Even if there was no statistically significant difference between

the patch and no-patch group there would be an argument in

favour of a no-patch policy. Wearing a patch renders the person

acutely monocular. This has important consequences for any tasks

where depth perception is required, for example when walking

or judging steps. Patients are not able to drive safely when they

have sudden monocular vision as they may be disoriented, have

decreased depth perception and have a decreased visual field. Acute

corneal abrasions can cause such pain that some patients may have

decreased visual acuity. However, the visual acuity may be normal

despite the pain and, by the second day, healing has often occurred

to the extent that patients have normal vision. Thus, returning for

follow up visits may be much easier for the patient if they don’t

need to rely on someone accompanying them.

A qualitative difference between the studies was the adjunctive

treatment applied to each group in the trials. There were differ-

ences in the use of cycloplegic drops, analgesia and antibiotics.

In the patch group, antibiotics were often administered prior to

patching and then only re-administered 24 hours later when the

patch was removed for inspection of the corneal abrasion. In con-

trast, the control group often received antibiotic drops or oint-

ment more regularly during the day. It is possible that the use of

the cycloplegics or ophthalmologic antibiotics may affect healing

rates enough to overshadow any benefit of patching.

Another theoretical problem associated with patching that has

been proposed is the warm, moist environment that might support

bacterial proliferation (Parrish 1988). Other problems include de-

creased oxygenation of the cornea, reduced epithelial turnover

and decreased elimination of cellular metabolism waste products,



which may interfere with the washout of bacteria. However, the

complication of infection was reported in such low numbers in

the trials that it would require very large numbers of participants

enrolled in the studies to demonstrate a difference between patch-

ing and no-patching.

This review contains a more thorough search of the grey literature

than either of the previous reviews on this topic (Flynn 1998;

Yamada 2001) and has included studies published in non-English

journals. This is important because just one trial showing a positive

treatment effect for the patch could alter the results of the meta-

analysis. This review also corrects errors in both aforementioned

reviews with respect to the trial by Jackson 1960 where data was

incorrectly assigned to day 2 rather than day 1 in the meta-analysis.

This review has revealed a lack of evidence to offer recommenda-

tions regarding large corneal abrasions (that is, more than 10 mm2). In these circumstances, some practitioners advocate the use of a

patch as they feel that something should be done to protect the eye

with such a large abrasion. This treatment option has not been in-

vestigated satisfactorily in randomised controlled trials. Only one

trial performed a subgroup analysis (Kaiser 1995). Even though

this was one of the largest trials included in this review there still

were not enough large abrasions to make the subgroup analysis

informative. Kaiser 1995 recommends that physicians treating pa-

tients with large abrasions as well as deeper stromal and partial-

thickness defects should continue to follow the currently accepted

standard of care of an antibiotic ointment, mydriatic drops and a

pressure patch. However, as mentioned, this treatment regimen is

not evidence-based.

A U T H O R S ’ C O N C L U S I O N S

Implications for practice

From the results of the meta-analyses, the no-patch groups had sig-

nificantly faster healing time on day one and no difference in pain

scores. For days two and day three there were no significant dif-

ferences between patched and non-patched eyes in terms of heal-

ing or level of discomfort. It is therefore reasonable to conclude

that patching the eye is not useful for the treatment of simple,

traumatic corneal abrasions. For most of the trials, an important

confounder of adjunctive drops and ointments means results need

to be interpreted with caution. Most trials are essentially compar-

ing patch and single antibiotic treatment versus multiple antibi-

otic treatment and no patch rather than simple patch versus no

patch. Treatment of large (> 10 mm2) abrasions is not addressed

adequately by current studies and therefore no recommendations

can be made.

Implications for research

Future studies in the area should no longer address small corneal

abrasions or those caused by foreign bodies. Instead, a large trial

looking at large corneal abrasions or those that are partial-thickness

defects involving the deeper stromal tissue of the cornea would

answer some useful and practical questions. A trial designed on

this topic would need to take into account all the flaws that were

found in the trials included in this review.

A C K N O W L E D G E M E N T S

• Michael Clarke (Supervisor of an MSc thesis at the

University of Oxford).

• Catey Bunce, Roberta Scherer, Stephanie Watson, Suzanne

Brodney-Folse for their comments on the review and/or protocol.

• Anupa Shah, Katherine Henshaw and Richard Wormald at

the Cochrane Eyes and Vision Group, London.

• Iris Gordon from the Cochrane Eyes and Vision Group

prepared and executed the updated electronic searches.

R E F E R E N C E S

References to studies included in this review

Agostini 2004 {published data only}

Agostini RM, da Rocha GMS, Miranda JC, de Aguiar

DV, Netto JA. Comparative study between eyepad and no

eyepad in the treatment of corneal abrasion secondary to

removal of corneal foreign body [Estudo comparativo entre

oclusao e nao–oclusao no tratamento de abrasao corneana

apos retirada de corpo estranho da cornea]. Arquivos

Brasileiros de Oftalmologia 2004;67:107–10.

Arbour 1997 {published data only}

Arbour JD, Brunette I, Boisjoly HM, Shi ZH, Dumas J,

Guertin MC. Should we patch corneal erosions. Archives of

Ophthalmology 1997;115:313–7.

Campanile 1997 {published data only}

Campanile TM, St. Clair DA, Benalm M. The evaluation

of eye patching in the treatment of traumatic corneal

epithelial defects. The Journal of Emergency Medicine 1997;

15:769–74.

Hulbert 1991 {published data only}

Hulbert MF. Efficacy of eyepad in corneal healing after

corneal foreign body removal. Lancet 1991;337(8742):643.



Jackson 1960 {published data only}

Jackson H. Effect of eye-pads on healing of simple corneal

abrasions. British Medical Journal 1960;2:713.

Kaiser 1995 {published data only}

Kaiser PK. A comparison of pressure patching versus no

patching for corneal abrasions due to trauma or foreign

body removal. Ophthalmology 1995;102:1936–42.

Kirkpatrick 1993 {published and unpublished data}

Kirkpatrick JNP, Hoh HB, Cook SD. No eye pad for

corneal abrasion. Eye 1993;7:468–71.

Le Sage 2001 {published and unpublished data}

Le Sage N, Verreault R, Rochette L. Efficacy of eye patching

for traumatic corneal abrasions: a controlled clinical trial.

Annals of Emergency Medicine 2001;28:129–34.

Michael 2002 {published data only}

Michael JG, Hug D, Dowd MD. Management of corneal

abrasion in children: a randomized clinical trial. Annals of

Emergency Medicine 2002;40:67–72.

Patterson 1996 {published data only}

Paterson J, Fetzer D, Krall J, Wright E, Heller M. Eye patch

treatment for the pain of corneal abrasion. Southern Medical

Journal 1996;89(2):227–9.

Rao 1994 {published data only}

Rao GP, Scott JA, King A, Blyth C, Ramesh A, Neoh C,

Kaye SB. No eye pad for corneal abrasion. Eye 1994;8:

371–2.

References to studies excluded from this review

Alper 1997 {published data only}

Alper BS. Using the pressure patch to treat corneal abrasions.

American Family Physician 1997;55(2):442.

Anonymous 2001 {published data only}

Anonymous. Patching for corneal abrasions. Journal of

Clinical Excellence 2001;3:41–2.

Daugherty 2002 {published data only}

Daugherty RJ. Efficacy of eye patching for traumatic corneal

abrasions: a controlled clinical trial. Clinical Pediatrics

2002;41(8):630.

Douglas 1999 {published data only}

Douglas M, Strelnick A. Corneal abrasions need not be

patched. The Journal of Family Practice 1999;48(1):8–9.

Easty 1993 {published data only}

Easty DL. Is an eye pad needed in cases of corneal abrasion?

. BMJ 1993;307:1022.

Gregersen 1991 {published data only}

Gregersen PL, Ottovay E, Kobayashi C, Hansen

SE, Bohnstedt J. Management of corneal abrasions

[Behandlingen af abrasio corneae]. Ugeskrift for Laeger

1991;153:2123–4.

Hart 1997 {published data only}

Hart A, White S, Conboy P, Quinton D. The management

of corneal abrasions in accident and emergency. Injury

1997;28(8):527–9.

Health 1996 {published data only}

Health C, Becker LA. Are eye patches necessary for corneal

abrasions?. The Journal of Family Practice 1996;42(5):454.

Hirst 1997 {published data only}

Hirst LW. Pressure patching for corneal abrasions.

Ophthalmology 1997;104(2):169.

Jampel 1995 {published data only}

Jampel HD. Patching for corneal abrasions. JAMA 1995;

274(19):1504.

Kurt 2003 {published data only}

Kurt E, Ozturk F, Inan U, Levent Emiroglu M, Sami Ilker

S. Efficacy of eye patching for corneal healing after removal

of corneal foreign body. Annals of Ophthalmology 2003;35

(2):114–6.

Le Claire 1996 {published data only}

Le Claire JE. Pressure patching versus no patching for

corneal abrasions. Ophthalmology 1996;103(6):866–7.

Mackway-Jones 1999 {published data only}

Mackway-Jones K, Carley S. Eye patches and corneal

abrasion. Journal of Accident and Emergency Medicine 1999;

16(2):136–7.

Melton 1991 {published data only}

Melton NR, Maino JH, Thomas RK. Management of

corneal abrasions. Optometry Clinics 1991;1:119–26.

Mindlin 1996 {published data only}

Mindlin AM. Treatment of corneal abrasions. JAMA 1996;

275(11):837.

Olson 1996 {published data only}

Olson ER. Pressure patching verus no patching for conreal

abrasions. Ophthalmology 1996;103(6):866–7.

Perlman 2000 {published data only}

Perlman EM. Patching the eye improves comfort and

healing in patients with corneal abrasions. Medicine and

Health 2000;83(12):395.

Rogers 1995 {published data only}

Rogers WB, Jampel JD. Patching for corneal abrasions.

JAMA 1995;274:1504.

Sabiston 1972 {published data only}

Sabiston DW. Eye-pads. The Practitioner 1972;209:673–5.

Sabri 1998 {published data only}

Sabri K, Pandit JC, Thaller VT, Evans NM, Crocker GR.

National survey of corneal abrasion treatment. Eye 1998;

12:278–81.

Schechter 1997 {published data only}

Schechter BA. Pressure patching for corneal abrasions.

Ophthalmology 1997;104(2):169–70.

Seiff 1996 {published data only}

Seiff SR. Pressure patching versus no patching for corneal

abrasions. Ophthalmology 1996;103(6):865–7.

Slawson 1996 {published data only}

Slawson DC, Shaughnessy AF. Treatment of corneal

abrasions. JAMA 1996;275(11):837.



Soli 2001 {published data only}

Soli C, Herbert ME. Myth: corneal abrasions require

routine patching. The Western Journal of Medicine 2001;

174(3):207.

Solomon 2000 {published data only}

Solomon A, Halpert M, Frucht-Pery J. Comparison of

topical indomethacin and eye patching for minor corneal

trauma. Annals of Ophthalmology 2000;32:316–9.

Spitz 1997 {published data only}

Spitz GF. Should we patch corneal erosions?. Archives of

Ophthalmology 1997;115(12):1607.

Yamada 2001 {published data only}

Yamada M, Kawai M, Mashima Y. Treatment of corneal

erosions. Folia Ophthalmologica Japonica 2001;52:911–6.

Additional references

Catalano 1992

Catalano RA. Foreign bodies and penetrating injuries

to the eye. In: Catalano RA, Belin M editor(s). Ocular

Emergencies. Philadelphia, PA: WB Saunders Co, 1992:

201–3.

ClinicalTrials.gov

ClinicalTrials.gov. http://www.clinicaltrials.gov/ (accessed

January 2004).

CRD 2006

Centre for Reviews and Dissemination. Should we patch

corneal abrasions: a meta-analysis. Database of Abstracts of

Reviews of Effectiveness (DARE) in: The Cochrane Library

2006, Issue 1. John Wiley & Sons, Ltd. Chichester, UK. [:

DARE–981808]

Cullom 1994

Cullom RD, Benjamin C. In: 2nd editor(s). The Wills Eye

Manual. Philadelphia: JB Lippincott Company, 1994.

DOH 2004

A and E Attendances Data 2002-2003.

www.performance.doh.gov.uk/hospitalactivity/

data requests/a and e attendances.htm (accessed 02 May

2005).

Edwards 1987

Edwards RS. Ophthalmic emergencies in a district

general hospital casualty department. British Journal of

Ophthalmology 1987;71:938.

Flynn 1998

Flynn CA, D’ Amico F, Smith G. Should we patch corneal

abrasions? A meta-analysis. Journal of Family Practice 1998;

47(4):264–70.

Glanville 2006

Glanville JM, Lefebvre C, Miles JN, Camosso-Stefinovic J.

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94(2):130–6.

Khaw 2004

Khaw PT, Shah P, Elkington AR. Injury to the eye. BMJ

2004;328(7430):36–8.

Kirkpatrick 2003

Kirkpatrick JN. Personal correspondence 2003.

Lai 2003

Lai T YY, Wong VWY, Leung GM. Is ophthalmology

evidence based? A clinical audit of the emergency unit of

a regional eye hospital. British Journal of Ophthalmology

2003;87(4):385–90.

Lubeck 1988

Lubeck D, Greene JS. Corneal Injuries. Emergency Medicine

Clinics of North America 1988;6(1):73–94.

Parrish 1988

Parrish CM, Chandler JW. Corneal Trauma. In: Kaufma

HE, Barron BA, McDonald MB, Waltman SR editor(s).

The Cornea. New York: Churchill Livingstone, 1988:

599–646.

Pavan-Langston 1991

Pavan-Langston D. Manual of Ocular Diagnosis and Therapy.

Boston, Massachusetts: Little Brown and Co, 1991.

Vaughan 1995

Vaughan D, Asbury T. General Ophthalmology. 14th

Edition. Norwalk, CT: Lange Medical Publications, 1995.

Webster 1987

Webster RG. Corneal Injuries. In: Smolin G, Thoft RA

editor(s). The Cornea: Scientific Foundations and Clinical

Practice. Boston, Massachusetts: Little, Brown and Co,

1987:517–42.

Wong 1998

Wong TY, Lincoln A, Tielsch JM, Baker SP. The

epidemiology of ocular injury in a major US automobile

corporation. Eye 1998;12(5):870–4.∗ Indicates the major publication for the study



C H A R A C T E R I S T I C S O F S T U D I E S

Characteristics of included studies [ordered by study ID]

Agostini 2004

Methods Parallel study design. 4 month duration.

Post-randomisation exclusions: 34% (unclear distribution).

Outcomes assessor and participants not masked.

Potential confounder: ointment used in both groups that contained vitamin A

Participants Inclusion criteria: foreign body only; >18 year old.

Exclusion criteria: contact lens users, corneal foreign body with infiltrate or organic matter, other trauma

to eye in addition to corneal foreign body.

Setting: Brazil.

Number of participants: 82.

Exclusions after randomisation: 28.

Total available for analysis: 54.

Median age: 34 years old.

Sex: Male:Female 53:1.

Interventions Double gauze pads firmly taped to prevent blinking. Used until complete healing. Epitezan (vitamin A,

Chloramphenicol ointment) used in both groups three times/day in non-patch group and once/day in

patched group

Outcomes Mean time to healing; pain scores VAS.

Notes All quality components unclear.

Risk of bias

Item Authors’ judgement Description

Allocation concealment? Unclear B - Unclear

Arbour 1997

Methods Randomised controlled trial with parallel design. 22 month duration. Unclear method of randomisation.


Outcomes assessors masked. Fluorescein stain (slit lamp) and photo/template drawing used to assess

epithelial erosion.

Potential confounder: different use of antibiotic ointment in two groups

Participants Inclusion criteria: presence of epithelial erosion greater than 1 mm; secondary to trauma or recurrent

erosion syndrome and spared Bowman membrane.

Exclusion criteria: signs of stromal, endothelial or neural corneal involvement (on slit lamp examination)

; previous patch; corneal abrasion secondary to removal of foreign body, infection, contact lens wear; use

of topical or systemic steroids; inability to comply with daily follow up.

Setting: Canada.



Arbour 1997 (Continued)




Mean age: in patched group 41.6 and in non-patched group 39.8 years old.

Sex: in patched group 32% female and in non-patched group 36% female

Interventions Double eye pad tightly taped with sufficient pressure to prevent lid opening. 2% homatropine and 10%

sulfacetamide were applied topically before patch applied. In non-patch group, 2% homatropine also used,

but antibiotic ointment applied twice daily. Oral analgesia (acetominophen and codeine) were prescribed

when needed for both groups

Outcomes Corneal photograph: linear and surface area rates of re-epithelialisation (mm/hour), perimeter, area of

erosion, diameter of largest circle included in erosion, shape index (ratio between perimeter and area of

erosion); discomfort; VAS score; insomnia; need for analgesia; follow up; compliance

Notes

Risk of bias



Campanile 1997

Methods Randomised controlled trial with parallel design. 7 month duration. Unclear method of allocation.

Post-randomisation exclusions 13.5% (unclear distribution).

Outcomes assessors masked (participants asked to remove patch and not mention it before assessment at

follow up). Fluorescein stain (slit lamp) and grid template/hand drawing used to assess outcomes.

Potential confounder: different usage of antibiotic ointment in two groups

Participants Inclusion criteria: 5 year old and above; traumatic corneal epithelial defects from corneal abrasion or

removal of foreign body.

Exclusion criteria: <5 years old; corneal disease; allergy to erythromycin.

Setting: USA.




Mean age: 31 (range 5 to 74).

Sex: 54.7% male.

Interventions Double gauze pads with first pad folded in half to prevent eyelid opening.

Patched group received one dose of erythromycin ointment.

Unpatched group received erythromycin ointment 4 times per day

Outcomes Percent healing (24 hours) collected from grid template hand drawing; mean initial abrasion size

Notes



Campanile 1997 (Continued)

Risk of bias



Hulbert 1991

Methods Randomised controlled trial. 3 month duration. Unclear method of allocation.

Post-randomisation exclusions 10% (unclear distribution).

Masking of outcomes assessor unclear. Fluorescein staining (X4 magnification) used to assess abrasion size

Participants Inclusion criteria: corneal epithelial defects resulting from removal of foreign body.

Exclusion criteria: participants in whom residual foreign body or stain remained after first attendance for

removal.

Setting: England.




No age and sex data.

Interventions Gauze with enough bulk to exert slight pressure on the closed eye, secured with bandage

Outcomes Number of days until complete healing; Number painful or painless on day 1 and 2

Notes

Risk of bias



Jackson 1960

Methods Quasi-randomised controlled trial. Unknown duration of trial. Alternate days for first attendance was

used as method of allocation.


Outcomes assessor not masked. Fluorescein stain (no slit lamp) was used to assess corneal abrasions.


Participants Inclusion criteria: superficial abrasion of the cornea.

Exclusion criteria: Any complicated lesion such as embedded foreign body or any other part of the eye.

Setting: England.






Jackson 1960 (Continued)

No age or sex data.

Interventions A cotton-wool pad covered by net, taped on.

All participants received sulphacetam 10% and if considered necessary, 1% atropine topically.

Participants without the eye pad continued to use the sulphacetam 10% antibiotic three times per day

Outcomes Number of days until complete healing.

Notes All quality components inadequate.

Risk of bias


Allocation concealment? No C - Inadequate

Kaiser 1995

Methods Randomised controlled trial with parallel design. Duration of trial unknown. Method of randomisation

unknown.

Outcomes assessors not masked.

Post-randomisation exclusions 10% (unclear distribution).

Fluorescein stain (with slit lamp) was used to assess corneal erosions. Full healing if score of 2 or less for

pain (on scale of 1010), or when only minor staining of epithelium.

Potential confounder: different usage of antibiotic ointment and mydriatic drops in two groups

Participants Inclusion criteria: traumatic corneal abrasion or removal of superficial foreign body of less than 36 hours’

duration; >18 years old; no history of eye trauma or disease in the affected eye; no other signs of ocular

trauma; simple epithelial defect without stromal oedema, loss, or infiltrate; no treatment before entering

the study.

Exclusion criteria: contact lens wearers; corneal dystrophies.

Setting: USA.




Mean age: 36.17, SD 11.93, range 19 to 78 years old.

Sex: 71% male.

Interventions Double eye patch with first pad folded in half, placed over closed eyelids and bandaged. Patched group

received mydriatic drops (2.5% phenylephrine/1% tropicamide) and erythromycin or polysporin antibi-

otic ointment once only before application of the patch. The non-patch group was treated with the same

topical agents 3 times per day for 5 days or until abrasion healed

Outcomes Number of days until complete healing. Healing considered to have occurred if score of 2 or below for pain,

or when only minor non-confluent superficial punctate staining of the corneal epithelium remained after

fluorescein administration; pain scores VAS (0-10), daily questions about symptoms such as photophobia,

tearing, foreign body sensation and blurred vision



Kaiser 1995 (Continued)

Notes

Risk of bias



Kirkpatrick 1993

Methods Randomised controlled trial with parallel design. 5 month duration. Coin-tossing used to achieve ran-

domisation.

Post-randomisation exclusions: 4.5% (n = 3 from patch group lost and n = 4 from non patch group lost).

Outcomes assessors not masked. Fluorescein stain (with slit lamp) used to assess abrasion. Approximate

area recorded.


Participants Inclusion criteria: >18 year old. Simple corneal abrasion, no treatment prior to trial inclusion.

Exclusion criteria: Previous history of eye trauma or disease in affected eye. Signs of significant ocular

trauma. Presence of foreign body.

Setting: England.




Mean age in patch group 36.3 years old and in non-patch group 35 years old.

No data on sex distribution.

Interventions Double eye pad with bandage until healed then chloramphenicol four times per day for three days. One

dose of chloramphenicol ointment and homatropine topically before eye pad applied.

Non patch group received chloramphenicol ointment four times per day and homatropine once per day

Outcomes Time to complete healing (epithelial edges opposed with only minor staining) - number of days. Size of

abrasion (maximum and minimum dimensions and approximate area), pain score VAS 1 to 100

Notes

Risk of bias





Le Sage 2001

Methods Quasi-randomised controlled trial. 21 month duration. Alternate allocation to groups.

Post-randomisation exclusions: 17% (n = 17 from patch group lost and n = 11 from non patch group

lost).

Outcomes assessors masked. Slit lamp used with dimensions of abrasion recorded on standardised form.


Participants Inclusion criteria: 18 to 60 year old, be able to report sufficient details of circumstances, timing of trauma.

Demonstrate corneal fluorescein uptake.

Exclusion criteria: corneal perforation, history of glaucoma, chemical burns, UV keratitis, bilateral abra-

sions, suspected corneal ulcers.

Setting: Canada.




Mean age in patch group 32 years old and in non-patch group 36 years old.

Sex: 82% male in patch group and 90% male in non-patch group

Interventions Double occlusive patch (worn until follow up ceased). Topical erythromycin ointment was used 4 times

per day in non-patch group and once per day in the patch group

Outcomes Time to complete healing.

Dimensions of corneal abrasions, pain using VAS, compliance, analgesic use, symptoms, mydriatics use

Notes

Risk of bias


Allocation concealment? No C - Inadequate

Michael 2002

Methods Randomised controlled trial with parallel study design. 9 month duration. Method of allocation was block

randomisation (groups of 4) placed in envelopes and numbered.

Post-randomisation exclusions: 5.4% (n=2 from non patch group).

Outcomes assessors were masked when measuring percent healing from photographs. Photograph/ tem-

plate drawing used to record abrasion size.


Participants Inclusion criteria: children 3 to 17 years old. Isolated corneal abrasion, ability to return for a follow up

examination.

Exclusion criteria: any other ocular trauma or any prior treatment for the corneal abrasion. Participants

with erythromycin allergy, who did not speak English, who had an eye infection, eye injuries or conditions

requiring inpatient care, or who had monocular vision.

Setting: USA.





Michael 2002 (Continued)


Mean age of all participants was 10 years.

Sex: 63% (n=22) were male.

Interventions Double eye patch with first pad folded in half and placed over closed eyelids, secured with tape to

provide pressure and prevent eyelid opening. All participants received 1% cyclopentolate. In the patched

group, one application of erythromycin ointment was applied topically. The non-patched group received

erythromycin ointment three times per day

Outcomes Percent healing at 24 hours.

Visual outcomes.

Analgesia use.

ADLs.

Notes All quality components adequate.

Risk of bias


Allocation concealment? Yes A - Adequate

Patterson 1996

Methods Randomised controlled trial. Duration of trial unknown. Allocation according to computer generated

table.

Post-randomisation exclusions: 34% (“almost equally divided” between groups).

No masking of outcomes assessor. Fluorescein stain (no slit lamp) used to document lesion.


Participants Inclusion criteria: Eye pain and documented corneal abrasion (on fluorescein staining). Cause may be

foreign body or mechanical disruption

Exclusion criteria: <12 years old, significant coexisting disease (eye), chemical/thermal injuries.

Setting: USA.




No age or sex data.

Interventions Double pressure patch, first patch folded in half, placed over closed eyelids, entirely covered with tape.

Patched group received topical antibiotic ointment before application of patch. Non-patched group re-

ceived antibiotic drops (unknown dosage)

Outcomes Pain scores VAS.

Analgesia use - ketoprofen at 24 hours.

Complete 24 hour healing.

Notes



Patterson 1996 (Continued)

Risk of bias



Rao 1994

Methods Randomised controlled trial. Duration of trial unknown.

Outcome measurement technique not described.

Post-randomisation exclusions 0%. Unclear regime of antibiotic ointment and mydriatic drops

Participants Setting: England.


Interventions Firm padding of the eye.

Both groups received topical cyclopentolate 1% and chloramphenicol ointment 1%

Outcomes Maximum or minimum length on days 1 and 2.

Pain scores, analgesia use.

Notes All quality components unclear.

Risk of bias



ADLs - activities of daily living

ITT - intention-to-treat

VAS - visual analogue scale

Characteristics of excluded studies [ordered by study ID]

Study Reason for exclusion

Alper 1997 Letter - no new data presented.

Anonymous 2001 Letter - no new data presented.

Daugherty 2002 Mini-review - no new data presented.



(Continued)

Douglas 1999 Letter - no new data presented.

Easty 1993 Letter - no new data presented.

Gregersen 1991 There is no control ’no-patch’ group. Two different types of patching are compared to each other in the

randomised trial

Hart 1997 Retrospective chart review/audit - no new data presented.

Health 1996 Letter - no new data presented.

Hirst 1997 Letter - no new data presented.

Jampel 1995 Letter - no new data presented.

Kurt 2003 Randomised controlled trial that included participants who had received an abrasion up to 7 days prior to

being included in the study. The mean time to seek ophthalmological attention was 2.1 days. This means

the study falls outside the study criteria defined as being abrasion of recent onset (<48 hours)

Le Claire 1996 Letter - no new data presented.

Mackway-Jones 1999 Mini-review - no new data presented.

Melton 1991 Letter - no new data presented.

Mindlin 1996 Letter - no new data presented.

Olson 1996 Letter - no new data presented.

Perlman 2000 Letter - no new data presented.

Rogers 1995 Letter - no new data presented.

Sabiston 1972 Letter - no new data presented.

Sabri 1998 National survey of corneal abrasion treatment - no new data presented

Schechter 1997 Letter - no new data presented.

Seiff 1996 Letter - no new data presented.

Slawson 1996 Letter - no new data presented.

Soli 2001 Letter - no new data presented.

Solomon 2000 Patching the eye is compared with no patching, however the groups differ significantly. The no-patch group

is treated with an alternative therapy (topical Indomethacin)



(Continued)

Spitz 1997 Letter - no new data presented.

Yamada 2001 A meta-analysis of previous studies. No new data presented.



D A T A A N D A N A L Y S E S

Comparison 1. PATCHING VERSUS NO PATCHING

Outcome or subgroup titleNo. of

studies

No. of

participants Statistical method Effect size

1 Number healed on day 1 7 531 Risk Ratio (M-H, Random, 95% CI) 0.89 [0.79, 1.00]



4 Mean number of days to

complete healing

6 561 Mean Difference (IV, Random, 95% CI) 0.14 [-0.00, 0.29]

5 Sensitivity analysis - number

healed on day 1 in trials with

masked outcome assessors

3 274 Risk Ratio (M-H, Random, 95% CI) 0.84 [0.69, 1.02]

6 Sensitivity analysis - number

healed on day 1 in trials that

excluded foreign bodies

3 241 Risk Ratio (M-H, Random, 95% CI) 0.87 [0.68, 1.12]

7 Sensitivity analysis - mean

days to healing in trials that

included foreign bodies

4 367 Mean Difference (IV, Random, 95% CI) 0.12 [-0.05, 0.30]



Analysis 1.1. Comparison 1 PATCHING VERSUS NO PATCHING, Outcome 1 Number healed on day 1.

Review: Patching for corneal abrasion

Comparison: 1 PATCHING VERSUS NO PATCHING

Outcome: 1 Number healed on day 1

Study or subgroup Patch No Patch Risk Ratio Weight Risk Ratio

n/N n/N

M-H,Random,95%

CI

M-H,Random,95%

CI

Arbour 1997 6/25 6/22 1.5 % 0.88 [ 0.33, 2.33 ]

Campanile 1997 21/31 27/33 17.3 % 0.83 [ 0.62, 1.11 ]

Hulbert 1991 14/16 14/14 30.6 % 0.88 [ 0.71, 1.10 ]

Jackson 1960 42/77 48/80 19.9 % 0.91 [ 0.69, 1.19 ]

Kirkpatrick 1993 5/17 10/20 2.0 % 0.59 [ 0.25, 1.39 ]

Le Sage 2001 42/82 49/81 19.4 % 0.85 [ 0.64, 1.11 ]

Patterson 1996 14/17 11/16 9.3 % 1.20 [ 0.81, 1.78 ]

Total (95% CI) 265 266 100.0 % 0.89 [ 0.79, 1.00 ]

Total events: 144 (Patch), 165 (No Patch)

Heterogeneity: Tau2 = 0.0; Chi2 = 3.50, df = 6 (P = 0.74); I2 =0.0%

Test for overall effect: Z = 1.91 (P = 0.056)

0.2 0.5 1 2 5

Favours no patch Favours patch







Study or subgroup Patch No patch Risk Ratio Weight Risk Ratio

n/N n/N

M-H,Random,95%

CI

M-H,Random,95%

CI

Jackson 1960 61/77 65/80 42.5 % 0.98 [ 0.83, 1.14 ]

Kirkpatrick 1993 13/17 19/20 12.9 % 0.80 [ 0.61, 1.07 ]

Le Sage 2001 64/82 67/81 44.5 % 0.94 [ 0.81, 1.10 ]

Total (95% CI) 176 181 100.0 % 0.94 [ 0.85, 1.04 ]

Total events: 138 (Patch), 151 (No patch)



0.2 0.5 1 2 5







n/N n/N

M-H,Random,95%

CI

M-H,Random,95%

CI

Jackson 1960 70/77 71/80 51.5 % 1.02 [ 0.92, 1.14 ]

Le Sage 2001 74/82 71/81 48.5 % 1.03 [ 0.92, 1.15 ]

Total (95% CI) 159 161 100.0 % 1.03 [ 0.95, 1.11 ]




0.2 0.5 1 2 5




Analysis 1.4. Comparison 1 PATCHING VERSUS NO PATCHING, Outcome 4 Mean number of days to

complete healing.



Outcome: 4 Mean number of days to complete healing

Study or subgroup Patch No patchMean

Difference WeightMean

Difference

N Mean(SD) N Mean(SD) IV,Random,95% CI IV,Random,95% CI

Agostini 2004 27 1.22 (0.42) 27 1.33 (0.55) 17.8 % -0.11 [ -0.37, 0.15 ]

Hulbert 1991 16 1.12 (0.33) 14 1 (0.01) 27.3 % 0.12 [ -0.04, 0.28 ]

Jackson 1960 77 1.79 (1.09) 80 1.74 (1.11) 12.6 % 0.05 [ -0.29, 0.39 ]

Kaiser 1995 62 2.69 (0.77) 58 2.33 (0.66) 18.2 % 0.36 [ 0.10, 0.62 ]

Kirkpatrick 1993 17 2 (0.71) 20 1.55 (0.61) 9.0 % 0.45 [ 0.02, 0.88 ]

Le Sage 2001 82 1.79 (0.97) 81 1.67 (0.99) 15.0 % 0.12 [ -0.18, 0.42 ]

Total (95% CI) 281 280 100.0 % 0.14 [ 0.00, 0.29 ]

Heterogeneity: Tau2 = 0.01; Chi2 = 8.68, df = 5 (P = 0.12); I2 =42%


-1 -0.5 0 0.5 1

Favours patch Favours no patch



Analysis 1.5. Comparison 1 PATCHING VERSUS NO PATCHING, Outcome 5 Sensitivity analysis - number

healed on day 1 in trials with masked outcome assessors.



Outcome: 5 Sensitivity analysis - number healed on day 1 in trials with masked outcome assessors


n/N n/N

M-H,Random,95%

CI

M-H,Random,95%

CI

Arbour 1997 6/25 6/22 4.0 % 0.88 [ 0.33, 2.33 ]

Campanile 1997 21/31 27/33 45.2 % 0.83 [ 0.62, 1.11 ]

Le Sage 2001 42/82 49/81 50.8 % 0.85 [ 0.64, 1.11 ]

Total (95% CI) 138 136 100.0 % 0.84 [ 0.69, 1.02 ]




0.2 0.5 1 2 5


Analysis 1.6. Comparison 1 PATCHING VERSUS NO PATCHING, Outcome 6 Sensitivity analysis - number

healed on day 1 in trials that excluded foreign bodies.



Outcome: 6 Sensitivity analysis - number healed on day 1 in trials that excluded foreign bodies


n/N n/N

M-H,Random,95%

CI

M-H,Random,95%

CI

Arbour 1997 6/25 6/22 6.6 % 0.88 [ 0.33, 2.33 ]

Jackson 1960 42/77 48/80 84.9 % 0.91 [ 0.69, 1.19 ]

Kirkpatrick 1993 5/17 10/20 8.5 % 0.59 [ 0.25, 1.39 ]

Total (95% CI) 119 122 100.0 % 0.87 [ 0.68, 1.12 ]




0.2 0.5 1 2 5




Analysis 1.7. Comparison 1 PATCHING VERSUS NO PATCHING, Outcome 7 Sensitivity analysis - mean

days to healing in trials that included foreign bodies.



Outcome: 7 Sensitivity analysis - mean days to healing in trials that included foreign bodies

Study or subgroup Patch No patchMean

Difference WeightMean

Difference

N Mean(SD) N Mean(SD) IV,Random,95% CI IV,Random,95% CI

Agostini 2004 27 1.22 (0.42) 27 1.33 (0.55) 23.0 % -0.11 [ -0.37, 0.15 ]

Hulbert 1991 16 1.12 (0.33) 14 1 (0.01) 33.9 % 0.12 [ -0.04, 0.28 ]

Kaiser 1995 62 2.69 (0.77) 58 2.33 (0.66) 23.5 % 0.36 [ 0.10, 0.62 ]

Le Sage 2001 82 1.79 (0.97) 81 1.67 (0.99) 19.6 % 0.12 [ -0.18, 0.42 ]

Total (95% CI) 187 180 100.0 % 0.12 [ -0.05, 0.30 ]

Heterogeneity: Tau2 = 0.02; Chi2 = 6.35, df = 3 (P = 0.10); I2 =53%


-1 -0.5 0 0.5 1


A D D I T I O N A L T A B L E S

Table 1. Quality Assessment Results

Trials Randomisation Allocation con-

ceal.

Masking Attrition Intention-to-treat Comparable groups

Jackson 1960 C C C C (65/222) C Yes

Hulbert 1991 B B B A (3/33) B Yes

Kirkpatrick

1993

A B C A (7/44) C Yes

Rao 1994 B B B A (0/40) B Yes

Kaiser 1995 B B C A (22/223) B Yes

Patterson 1996 A B C A (17/50) C Yes



Table 1. Quality Assessment Results (Continued)

Arbour 1997 B B A A (1/46) C Yes

Campanile 1997 B B A A (10/74) C Yes

Le Sage 2001 C C A A (28/163) B Yes

Michael 2002 A A A A (2/37) A Yes

Agostini 2004 B B B C (28/82) C Yes

A P P E N D I C E S

Appendix 1. CENTRAL search strategy used for Issue 4, 2007

#1 MeSH descriptor Cornea

#2 MeSH descriptor Corneal Diseases

#3 MeSH descriptor Epithelium, Corneal

#4 MeSH descriptor Eye Injuries

#5 (#1 OR #2 OR #3 OR #4)

#6 MeSH descriptor Wounds and Injuries

#7 injur* or abrasion* or erosion* or trauma* or wound* or foreign bod*

#8 (#6 OR #7)

#9 eye* or cornea*

#10 (#8 AND #9)

#11 (#5 OR #10)

#12 MeSH descriptor Occlusive Dressings

#13 patch* or bandage* or plaster* or wool* or dress* or pad* or gauze or occlusi*

#14 (#12 OR #13)

#15 (#11 AND #14)

Appendix 2. MEDLINE search strategy on OVID up to December 2007

1 exp clinical trial/ [publication type]

2 (randomized or randomised).ab,ti.

3 placebo.ab,ti.

4 dt.fs.

5 randomly.ab,ti.

6 trial.ab,ti.

7 groups.ab,ti.

8 or/1-7

9 exp animals/

10 exp humans/

11 9 not (9 and 10)

12 8 not 11



13 exp cornea/

14 exp corneal diseases/

15 exp epithelium corneal/

16 exp eye injuries/

17 or/13-16

18 exp “wounds and injuries”/

19 (injur$ or abrasion$ or erosion$ or trauma$ or wound$ or foreign bod$).tw.

20 or/18-19

21 (eye$ or cornea$).tw.

22 20 and 21

23 17 or 22

24 exp occlusive dressings/

25 (patch$ or bandage$ or plaster$ or wool$ or dress$ or pad$ or gauze or occlusi$).tw.

26 or/24-25

27 23 and 26

28 12 and 27

The search filter for trials at the beginning of the MEDLINE strategy is from the published paper by Glanville (Glanville 2006).

Appendix 3. EMBASE search strategy on OVID up to December 2007

1 exp randomized controlled trial/

2 exp randomization/

3 exp double blind procedure/

4 exp single blind procedure/

5 random$.tw.

6 or/1-5

7 (animal or animal experiment).sh.

8 human.sh.

9 7 and 8

10 7 not 9

11 6 not 10

12 exp clinical trial/

13 (clin$ adj3 trial$).tw.

14 ((singl$ or doubl$ or trebl$ or tripl$) adj3 (blind$ or mask$)).tw.

15 exp placebo/

16 placebo$.tw.

17 random$.tw.

18 exp experimental design/

19 exp crossover procedure/

20 exp control group/

21 exp latin square design/

22 or/12-21

23 22 not 10

24 23 not 11

25 exp comparative study/

26 exp evaluation/

27 exp prospective study/

28 (control$ or prospectiv$ or volunteer$).tw.

29 or/25-28

30 29 not 10

31 30 not (11 or 23)

32 11 or 24 or 31



33 exp cornea/

34 exp cornea disease/

35 exp cornea epithelium/

36 exp eye injury/

37 or/33-36

38 exp injury/

39 (injur$ or abrasion$ or erosion$ or trauma$ or wound$ or foreign bod$).tw.

40 or/38-39

41 (eye$ or cornea$).tw.

42 40 and 41

43 37 or 42

44 (patch$ or bandage$ or plaster$ or wool$ or dress$ or pad$ or gauze or occlusi$).tw.

45 43 and 44

46 32 and 45

Appendix 4. LILACS search strategy used on 3 December 2007

injur$ or abrasion or erosion or trauma or foreign bod$ and eye$ or cornea$ and patch$ or bandage$ or plaster$ or wool$ or dressing$

or pad$ or gauze or occlus$

Appendix 5. NRR search strategy used for Issue 4, 2007

#1. (injur* or abrasion or erosion or trauma or (foreign next bod*))

#2. (eye* or cornea*)

#3. (#1 and #2)

#4. (patch* or bandage* or plaster* or wool* or dressing* or pad* or gauze or occlus*)

#5. (#3 and #4)

Appendix 6. SIGLE search strategy used to December 2004

#1 foreign next bod*

#2 trauma* near (eye* or cornea*)

#3 cornea* near (injur* or abrasion* or erosion*)

#4 #1 or #2 or #3

#5 patch* or bandage* or plaster* or wool or dressing* or pad or pads or padding or gauze or occlusi* or contact lens*

#6 #4 and #5

W H A T ’ S N E W

Last assessed as up-to-date: 2 December 2007.

Date Event Description

26 October 2008 Amended Converted to new review format.



H I S T O R Y

Protocol first published: Issue 2, 2004

Review first published: Issue 2, 2006

C O N T R I B U T I O N S O F A U T H O R S

Conceiving the review: AT

Designing the review: AT, MR

Coordinating the review: AT

Undertaking manual searches: AT, MR

Screening search results: AT, MR

Organising retrieval of papers: AT

Screening retrieved papers against inclusion criteria: AT, MR

Appraising quality of papers: AT, MR

Abstracting data from papers: AT, MR

Writing to authors of papers for additional information: AT

Obtaining and screening data on unpublished studies: AT, MR

Data management for the review: AT, MR

Entering data into RevMan: AT, MR

Analysis of data: AT, MR

Interpretation of data: AT, MR

Writing the review: AT

D E C L A R A T I O N S O F I N T E R E S T

None known.

S O U R C E S O F S U P P O R T

Internal sources

• No sources of support supplied



External sources

• Rhodes Trust, UK.

I N D E X T E R M S

Medical Subject Headings (MeSH)

∗Occlusive Dressings; Cornea [∗injuries]; Eye Foreign Bodies [complications]; Randomized Controlled Trials as Topic

MeSH check words

Humans



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