THE EVALUATION OF BANDAGE CONTACT LENSES AS A PRIMARY TREATMENT FOR TRAUMATIC CORNEAL ABRASIONS
Journal Title: European Journal of Biomedical and Pharmaceutical Sciences - Year 2019, Vol 6, Issue 11
Abstract
Background: Corneal abrasions are a common result of eye trauma. Corneal injuries are very common in both the adult and paediatric population and account for a significant proportion of the workload of most emergency departments. Although they usually heal well with conservative therapy, they still tend to be a source of morbidity, in terms of pain and lost work time. Corneal abrasions result from cutting, scratching, or abrading the thin, protective, clear coat of the exposed anterior portion of the ocular epithelium. These injuries cause pain, tearing, blepharospasm, photophobia, foreign body sensation, decreased visual acuity/blurring, and a gritty feeling. Symptoms can be worsened by exposure to light, blinking, and rubbing the injured surface against the inside of the eyelid. Most corneal abrasions heal in 24 to 72 hours and rarely progress to recurrent corneal erosion or infection. The aim of the study is to use bandage soft contact lenses as a primary treatment for traumatic corneal abrasion instead of traditionally use pad & bandage(eye patching). Patients & Methods: The present prospective study has been conducted on 50 patients attending the out-patient department of ophthalmology in a Alyarmouk teaching hospital for a period of six months after taking ethical permission. Hydrophilic bandage soft contact lenses were used. Before subjecting the patient to treatment of therapeutic lens therapy, a detail clinical history and thorough local examination has been done. A history indicating the occurrence of recent ocular trauma followed by severe pain, redness, blepharospsm, photophobia and tearing of the involved eye is suggestive of a corneal abrasion. Always we ask about contact lens wear as this can complicate the presence of an abrasion. To confirm the diagnosis of corneal abrasion we examine the cornea by slitlamp under cobalt-blue filtered light after the application of tetracaine drops & fluorescein strips. The treatment of 50 consecutive patients presenting with traumatic corneal abrasion has been treated with anaesthetic drops (tetracaine0. 5%)to relieve pain and blepharospasm, antibiotic drops (ofloxacin 0. 3%), therapeutic bandage soft contact lenses was applied to provide pain relief and once again act as a splint to promote epithelial healing, then visual acuty was measured by Snellen chart, a cycloplegic drops (cyclopentolate1%) was applied to relieve ciliary spasm & then preservative free lubricant eye drops was applied lastly. This criteria dramatically relieves most, if not all of the pain the patient may be experiencing (which is a big plus for the patient and earns instantaneous trust), but it also allows the patient to return to work/school or any other daily activities. Patients has been evaluated after 24hour, 3days and after 1week regarding pain, visual acuity and complications. Although eye patching traditionally has been recommended in the treatment of corneal abrasions, patching does not help and may hinder healing. Corneal abrasions can be avoided through the use of protective eyewear. Results: Total 50 cases were enrolled in our study during the study period of 6 months. Out of 50 patients, there were 30males and 20 females and male/female ratio was 3:2. The patient age was ranged from 5-35years. The commonest cause of injury was direct minor trauma (80% of cases), with cosmetic & optical contact lenses related problems accounting for 20% of presentations, visual acuity was documented correctly in 90% of adult and pediatric group and difficult to doucmented in children less than 6 year old 10%. Traumatic corneal abrasions treated with bandage soft contact lenses has an apparent advantage over the traditional occlusion in terms of reduced pain during healing, speedier healing, advantage of faster rehabilitation, achieving the goals of pain reduction, facilitation epithelial healing, and proper surface hydration. Evaluation of pain revealed sufficient comfort with this regimen, allowing 45 patients (90%) to go back immediately to their occupations. Moreover, visual function is retained without any complication. Healing of the corneal abrasions occurred within 1 to 3 days in all patients, with minimal or no pain. No corneal infection occurred. We remove the bandage soft contact lenses after 1 week to allow epithelial migration and attachment without the interference of the shearing forces of the upper lid. Conclusions: The use of bandage soft contact lenses as a primary treatment for traumatic corneal abrasion is a safe and effective method with antibiotic drops ofloxacin 0. 3%, cyclopentolate 1% drops, preservative free lubricant drops instead of traditionally pad and bandage. Bandage soft contact lens causes dramatic improvement from pain, lid spasm, tearing & visual function is retained without any complication and patients can immediately resume their regular activities.
Authors and Affiliations
Dr. Hashim Thiab Hassan FIBOphth, MRCOphth.
Keywords
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