Letters to the Editor

Is Ophthalmologic Follow-Up for Corneal Abrasions Needed?

Am Fam Physician. 2004 Jul 1;70(1):32.

to the editor: We read with great interest the article “Prevention and Treatment of Common Eye Injuries in Sports,”1 in the April 1, 2003 issue of American Family Physician. Overall, we found it to be a concise and informative article. However, in Table 3 , the authors state that “24-hour ophthalmologic follow-up is mandatory” in the treatment of corneal abrasions.1 It has been our experience that uncomplicated corneal abrasions may be followed up appropriately by the primary care physician in the clinic, emergency department, or urgent care facility.

Although a brief literature review found various and differing recommendations for follow-up, we were not able to find any evidence (i.e., original outcome-based research) supporting these recommendations. Two of the most popular emergency medicine textbooks2,3 recommend 24-hour follow-up for patients with corneal abrasions but do not specify that this must be conducted by an ophthalmologist. A leading ophthalmologic textbook4 also does not recommend or mandate ophthalmologic follow-up.

A study5 of practices in Great Britain noted that only 50 to 60 percent of follow-up was performed by the ophthalmologic house officer. In their conclusion, they propose that “general practitioners play an increasingly active role in the diagnosis, treatment and follow-up of patients.”5

In summary, while there is consensus that next-day follow-up is necessary for patients with corneal abrasions, evidence is lacking to support the need for mandatory 24-hour ophthalmologic follow-up. Our concern is that by making such a strong statement, these authors’ may be contributing to the creation of a new “standard of care” without providing supporting evidence. The consensus appears to be that referral to an ophthalmologist is not indicated in the absence of complicating factors.

LEO BUNUEL-JORDANA, D.O.

DAVID C. FIORE, M.D.

University of Nevada School of Medicine

Department of Family and Community Medicine

Brigham Building, MS 316

Reno, NV 89557

References

1. Rodriguez JO, Lavina AM, Agarwal A. Prevention and treatment of common eye injuries in sports. Am Fam Physician. 2003;67:1481-8

2. Marx JA, Hockberger RS, Walls RM, Adams J, eds. Rosen’s Emergency medicine: concepts and clinical practice. 5th ed. St. Louis: Mosby, 2002:915–6.

3. Tintinalli JE, Kelen GD, Stapczynski JS, eds. Emergency medicine: a comprehensive study guide. 5th ed. New York: McGraw-Hill, Health Professions Division, 2000:1508–9.

4. Albert DM, Jakobiec FA, eds. Principles and practice of ophthalmology: clinical practice. Vol. 5. Philadelphia: W.B. Saunders, 1994:3384–5.

5. Sabri K, Pandit JC, Thaller VT, Evans NM, Crocker GR. National survey of corneal abrasion treatment. Eye. 1998;12:278-81

editor’s note: This letter was sent to the authors of “Prevention and Treatment of Common Eye Injuries in Sports,” who declined to reply.

 

Send letters to Kenneth W. Lin, MD, MPH, Associate Deputy Editor for AFP Online, e-mail: afplet@aafp.org, or 11400 Tomahawk Creek Pkwy., Leawood, KS 66211-2680.

Please include your complete address, e-mail address, and telephone number. Letters should be fewer than 400 words and limited to six references, one table or figure, and three authors.

Letters submitted for publication in AFP must not be submitted to any other publication. Possible conflicts of interest must be disclosed at time of submission. Submission of a letter will be construed as granting the American Academy of Family Physicians permission to publish the letter in any of its publications in any form. The editors may edit letters to meet style and space requirements.


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