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
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.
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