Eye injuries, most specifically corneal abrasions, account for a significant number of visits to the emergency department and to physician offices. The most common causes of corneal abrasions in children are foreign bodies and direct trauma to the eye. Symptoms in older children include photophobia and pain. Tearing, redness, blurred vision and foreign body sensation also are common. Although rare, complications such as bacterial infection, ulceration or iritis can develop if the abrasion is not treated. Treatment typically includes a topical antibiotic and eye patching for at least 24 hours. Most physicians also require a follow-up visit at 24 hours to assess for infection and to evaluate whether the abrasion is resolving. This follow-up visit is commonly recommended but of unproven benefit. Rittichier and colleagues conducted a retrospective study to evaluate whether the signs and symptoms associated with a corneal abrasion are predictive of fluorescein findings after 24 hours of treatment. They hypothesized that results of fluorescein staining in the affected eye would be normal in a symptom-free patient.
Medical records of patients with a diagnosis of corneal abrasion who had a documented follow-up visit at 24 to 48 hours were evaluated over a four-year period. Presenting signs and symptoms were noted and compared with those found at the follow-up visit. Visual acuity and treatment rendered at the initial visit also were recorded. Sensitivity, specificity, and positive and negative predictive values were calculated for all signs and symptoms present at the follow-up visit.
A total of 259 subjects were diagnosed with a corneal abrasion during the study period. Of these, 126 had a follow-up visit. Seventy-seven patients, ranging from four to 21 years of age (median: seven years), met the inclusion criteria for the study. Most patients (79 percent) included in the analysis had an abrasion secondary to minor trauma. Pain and redness were the most common presenting symptoms in all ages. Of interest, 95 percent of the subjects were treated with an eye patch.
The abrasion resolved in 51 patients after 24 to 48 hours. The remaining 26 patients had a persistent abrasion. Of these, 15 had only redness, six were asymptomatic and five remained symptomatic. The accompanying table shows sensitivities, specificities and positive and negative predictive values of the signs and symptoms at follow-up. Of the six children who were asymptomatic, five had complete resolution of the abrasion and one was lost to follow-up. Of the 20 patients who had redness or other symptoms at follow-up, two had rust rings removed and one had a foreign body removed. All corneal abrasions had completely resolved by the third visit. There was no change in the treatments between visits, and no complications were noted in any of the subjects at follow-up.
The authors conclude that the absence of ocular signs or symptoms is a poor predictor of a persistent corneal abrasion. In this study, one third of the patients had a persistent abrasion at follow-up, and 23 percent of these were asymptomatic. Therefore, the authors recommend a more selective approach for identifying patients who need follow-up. Patients who have persistent symptoms after 24 hours should be reevaluated for complications, persistent abrasion or the presence of a foreign body. Patients who are asymptomatic after 24 to 48 hours may require only selective follow-up, with the understanding that some of them will have persistent, but uncomplicated, abrasions.