Safety and Effectiveness of Topical Anesthetics in Corneal Abrasions: Systematic Review and Meta-Analysis

Abstract

Background: Topical anesthetics are used in the emergency department (ED) to relieve eye pain and allow eye examinations in patients with corneal abrasions. There is concern for delayed corneal healing, which is associated with the long-term use of topical anesthetics, so outpatient use is not recommended.

Objectives: We sought to systematically study the effectiveness and complications associated with the short-term use of topical anesthetics (≤72 hours) in the management of patients presenting to EDs with corneal abrasions.

Methods: Four electronic databases were searched from inception of the database until April 2014. We included studies of patients >16 years of age who were using topical anesthetics for <72 hours. Postoperative cases were not included.

Results: A total of 140 patients (68 in the intervention group and 72 in the control group) from 2 randomized trials were included in the analysis. Comparing control patients who did not use topical anesthetics to study patients who did use topical anesthetics, this meta-analysis found no significant difference in pain scores (standardized mean difference -1.01 [95% confidence interval {CI} -2.39 to 0.38), corneal healing (OR 1.31 [95% CI 0.53-3.27), or persistent symptoms (OR 0.98 [95% CI 0.06-16.69). The 2 trials reported no adverse effects.

Conclusion: There were no differences regarding pain, persistent symptoms, or corneal healing when comparing short-term use of topical anesthetics to placebo in the treatment of corneal abrasion. Data on safety are sparse, and the use of this treatment is currently not supported by evidence.

Keywords: adverse effects; complications; corneal abrasions; corneal healing; effectiveness; emergency department; eye pain; meta-analysis; pain scores; persistent symptoms; satisfaction; systematic review; topical anesthetics.