Question

In patients with acute corneal abrasions treated in the acute care setting, will ophthalmic NSAIDs decrease the pain associated with acute corneal abrasion as well as or better than placebo, oral analgesics, or standard therapy without impairing healing?

Reviewed by

Brown MD, Cordell WH, Gee AS

Date

July 1, 1999

Expiration date

July 1, 2000

Clinical bottom line

Ophthalmic NSAIDs appear to be a potentially useful therapy for controlling pain in patients with corneal abrasions. Two studies using ophthalmic NSAIDs demonstrated greater pain relief and improvement of other subjective symptoms when compared with placebo. How large of a treatment effect existed was difficult to determine in both studies.

Search strategy

No meta-analysis or systematic review was identified. MEDLINE was searched by way of the Web-based Ovid search engine: explode “Cornea/in [Injuries]” AND explode “Anti-inflammatory agents, non-steroidal” (as MeSH terms); limited to “human,” “English language,” and “clinical trials” from years 1966 to July 1999.

Citations

1. Jayamanne DG, Fitt AW, Dayan M, et al: The effectiveness of topical diclofenac in relieving discomfort following traumatic corneal abrasions. Eye 1997;11:79-83.

2. Kaiser PK, Pineda R II: A study of topical nonsteroidal anti-inflammatory drops and no pressure patching in the treatment of corneal abrasions. Corneal Abrasion Patching Study Group. Ophthalmology 1997;104:1353-1359.

Study characteristics

Study population

Kaiser and Pineda: Adults with a diagnosis of traumatic corneal abrasion (a simple epithelial defect <10 mm², without stromal edema, loss or infiltrate) or removal of superficial corneal foreign body of <36 hours. Excluded if <18 years treatment.old, contact lens user, previous history of eye trauma or disease in the affected eye, other signs of ocular trauma, or prior

Jayamanne et al: Adults presenting with corneal abrasion of <24 hours. Excluded if <18 years old, previous history of corneal pathology or hypersensitivity to NSAIDs or chloramphenicol.

Interventions

Kaiser and Pineda: Ketorolac tromethamine 0.5% ophthalmic solution or placebo instilled four times a day for 5 days or until healed, erythromycin or polymyxin B ointment three times a day, cycloplegic drugs, oral analgesics (acetaminophen, ibuprofen, aspirin).

Jayamanne et al: Diclofenac 0.1% ophthalmic solution or placebo instilled four times a day until healed (96 hours), chloramphenicol ointment, and oral analgesics.

Outcomes

Kaiser and Pineda: Ordinal pain scale assessment (0-10), photophobia, foreign body sensation, tearing, blurry vision, days until healed, and days until able to resume normal activities.

Jayamanne et al: Continuous visual analog scale, categorical pain scale (none, mild, moderate, severe), and qualitative classification of pain (photophobia, foreign body sensation, and headache-like pain). “Moderate pain” in the categorical scale was defined as the need for analgesics.

Critical appraisal

Kaiser and Pineda: Randomized, blinded with 88% follow-up. Groups similar at start of trial. Use of analgesics other than study therapy not controlled for. Quality rating: “good.”

Jayamanne et al: Randomized, blinded with 100% follow-up. Characteristics of groups at start of trial, including initial pain scores incompletely reported. Quantity of analgesics other than study therapy not fully controlled for. Quality rating: “fair.”

Results

Kaiser and Pineda: On day 1, ketorolac subjects had a mean pain intensity reduction of 2.7 compared with 1.4 in controls (P =.002 for comparison between the 2 groups). Fewer ketorolac subjects experienced photophobia and foreign body sensation.

Jayamanne et al: On day 1, diclofenac subjects had a statistically significant pain reduction on the categorical pain scale and on the VAS scale compared with placebo. Because the reductions in the pain score were not reported for the 2 groups, the clinical significance is unclear.