Advice to a patient regarding the use of eye patches following a corneal abrasion
Mr X attended the Minor Injuries department with a queried foreign body in his right eye which had caused a slight (2mm) corneal abrasion and was causing him pain. This type of injury will normally self-heal rapidly within 24 to 72 hours, but usually be painful with symptomology aggravated by exposure to light, blinking and the injury rubbing against the inside of the eyelid (Wilson & Last, 2004). Mr X was experiencing moderate discomfort and enquired whether he should wear an eye patch following discharge.

One of the “traditional” (Wilson & Last, 2004; Turner & Rabiu,2007) approaches to managing corneal abrasions of this type was to use an eye patch. Webb (1996) recommends patching the eye with two eye pads for a period of 24 hours for “patient preference”, as he noted that there was no benefit to the healing process. Purcell (2003) confirms Webb’s thoughts on patient preference adding that patching should always be carried out if the eye has been treated with anaesthetic drops to protect it whilst desensitised. Marsden (2002), supports the use of eye patches only to make the patient more comfortable and to offer a choice (patch or no patch), disagreeing with Purcell (2003) that patches should always be used with anaesthetic on the basis that the eye is desensitised for a short period of time and patching has no clinical benefits. Templeton and Wilson (1983) state that a firm pad and bandage should be applied to the eye to prevent excessive eye movement over the lesion.

However, Khaw et al (2004a) adopted a different approach to corneal abrasion management in stating that the aim of using an eye-patch was to promote “speed healing and protect the eye”. The “healing” aspect of their conclusion was at odds with the available research at that time and the article prompted several letters from readers, e.g. Kahn (2004), Kapur (2004). They disputed Khaw et al’s (2004) conclusions drawing attention to research proposing that eye patches had no impact on either healing times or pain control. This essay will consider the available research on the subject which will clarify the advice to give to Mr X for the management of his injury.

Arbour et all (1997) undertook a study to examine the effect of using an eye-patch on the speed of reepithelialisation, signs of epithelial wound healing and the pain or discomfort being experienced by the patient. All subjects (n=46) had injuries similar to Mr X i.e. the abrasion was regarded as small (10mm, had not been adequately covered.

There are other problems associated with eye patches. Wilson & Last (2004) confirm Arbour et al’s findings that patches may be a cause of pain but go further by proposing that children with patches found it more difficult to walk compared to children without patches, and that decreased oxygen delivery caused increase moisture and a higher chance of infection. They concluded that patching may actually hinder the healing process.

Khaw et al (2004b) subsequently qualified the comments regarding patching in their earlier article by stating that their proposal to patch all eye wounds was a misprint and the recommendation should have been confined to larger abrasions (>10mm). They cited Kaiser’s (1995) study in which the healing rates of such injuries was significantly improved if the eye was patched. Mattox et al (2000) support this view and underline the importance of preventing the eye opening below the patch which, if allowed to do so, can cause significantly more damage to the corneal epithelium than the abrasion itself.

It is also useful to consider the patient’s lifestyle in determining whether to use a patch or not. For example, if there is a need for the patient to drive during the next 24-48 hours, best advice would be not to patch. Wingate (1999) and Marsden (2002) warn about the loss of binocular vision if patches are applied and clearly driving would be dangerous.

Mr X was able to make an informed choice about wearing a pad according to the available evidence. As the abrasion was small, applying a patch would have no positive impact on healing nor would it reduce the chances of infection, in fact, there is some evidence that a patch might hinder recovery. However, the downside risks appear small. There is a body of evidence that the patient should have a choice as to whether a patch is worn and the determining factor should be what feels more comfortable – and if the patient finds it uncomfortable, then it may simply be removed with no negative impact on recovery.

Arbour, J.D., Brunette, I., Boisjoly, H.M., Shi, Z.H., Dumas, J. and Guertin M.C. (1997). Should we patch corneal erosions? Archives of Opthalmology; 115(3); 313-7.

Calder,L. Balasubramanian,S. and Stiell, I. (2004). Lack of consensus on corneal abrasion management: results of a national survey. Journal of the Canadian Association of Emergency Physicians; Nov 2004; 6, 6;

Kahn,R.S. (2004). Eye padding not recommended for corneal abrasions. In Rapid Response to Clinical Review - Khaw, P.T., Shah,.P and Elkington, A.R. (2004). ABC of Eyes: Injury to the eye. British Medical Journal; 2004 (328) 36-38. http://www.bmj.com/cgi/eletters/328/7430/36 [online] (26.05.08)

Kapur, A.K. (2004). ABC should incorporate EBM. In Rapid Response to Clinical Review - Khaw, P.T., Shah,.P and Elkington, A.R. (2004). ABC of Eyes: Injury to the eye. British Medical Journal; 2004 (328) 36-38. http://www.bmj.com/cgi/eletters/328/7430/36 [online] (26.05.08)

Khaw, P.T., Shah,.P and Elkington, A.R. (2004a). ABC of Eyes: Injury to the eye. British Medical Journal; 2004 (328) 36-38.

Khaw, P.T., Shah,.P and Elkington, A.R. (2004b). ABC of Eyes: Injury to the eye. Authors Reply. British Medical Journal; 2004 (328) 644.

Marsden, J. (2002). Opthalmic trauma in the emergency department. Accident and Emergency Nursing; 2002 (10): 136-142.

Mattox, K.L.; Feliciano, D.V. and Moore E.E. (2000). Trauma. McGraw-Hill. New York.

Purcell, D. (2003). Minor Injuries: A Clinical Guide for Nurses. Elsevier. Edinburgh.

Templeton, J. and Wilson, R.I. (1983). Lecture Notes on Trauma. Blackwell Wcienific. Oxford.

Turner, A. and Rabiu, M. (2006). Patching for corneal abrasions. American Family Physician; 74(11) 1857

Webb, L.A. (1996). Eye Emergencies: Diagnosis and Management. Butterworth Heinemann. Oxford.

Wilson, S.A. and Last, A. (2004). Management of corneal abrasions. American Family Physician; 2004 (70) 123-130

Wingate, S. (1999). Treating corneal abrasions. Nurse Practitioner; 24 (6): 53.