Patching for Corneal Abrasions?

Clinical Question

Is patching an effective treatment for simple corneal abrasions?

Evidence-Based Answer

Patching is not beneficial for the treatment of simple corneal abrasions as measured by time to healing, complete healing rates at 24 to 48 hours, or pain.

Practice Pointers

Corneal abrasions are superficial defects of the corneal epithelium that most commonly result from mechanical injuries to the cornea. Experts have long recommended patching (occlusion of the affected eye) for the treatment of simple abrasions; however, recent studies have questioned this traditional guidance.¹

Eleven prospective randomized or quasi-randomized controlled trials were identified that studied the effectiveness of patching as measured by corneal healing in children and adults with corneal abrasion. All trials had two treatment groups with participants randomized to wear a patch for 24 hours or no patch; both treatment groups received variable dosing regimens of topical medications, including topical antibiotics, steroids, and cycloplegic eye drops.

Five trials measured the number of participants with complete healing (defined by no fluorescein staining) on each day of follow-up; two trials measured mean time to healing; and six trials measured percentage of healing or abrasion dimension sizes at each day of follow-up. Secondary outcomes measured in the trials included pain scores, analgesia use, treatment compliance, and ability to complete activities of daily living. Three trials mentioned short-term adverse events, and four trials reported long-term complications and follow-up two to seven months after the corneal abrasion. Overall, the studies were rated as being of poor quality because of uncertain adequacy of randomization, lack of intention-to-treat analyses, and high drop-out rates.

Meta-analysis of seven trials reporting complete healing rates on the first day of follow-up showed that more participants in the no-patch group had complete healing (risk ratio = 0.89; 95% confidence interval, 0.79 to 0.99). When the two quasi-randomized trials were excluded from the pooled analysis, the difference in complete healing rates between the groups was nonsignificant. Pooled analysis of studies reporting complete healing rates at day 2 and day 3 of follow-up showed no significant difference between the patch and no-patch groups. Analysis of six studies showed no significant difference between the patch and no-patch groups in the mean number of days to healing.

The nine trials measuring pain had conflicting results: two studies found less pain in the no-patch group, three studies found less pain in the patch group, and four studies found no significant difference. No differences were found in analgesia use, activities of daily living measures, patient compliance, presence of symptoms (e.g., photophobia, tearing, foreign-body sensation, blurred vision), use of mydriatic drops, or complications.

Adverse effects of patching include a loss of binocular vision while the patch is in place, which renders activities requiring depth perception (e.g., walking, driving) challenging. One study involving children showed that those in the patch group had significantly greater difficulty walking than those in the no-patch group.

This review addresses abrasions of less than 0.02 square inches (10 mm²); treatment of larger abrasions has not been adequately addressed.