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 ...view middle of the document...
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...