Classic corneal abrasion treatment in children is based on adult experience and includes the use of eye patching, cycloplegic drops, and antibiotics. However, recent studies with adults confirmed that patching, previously thought to relieve pain by decreasing eyelid movement over the injury, does not aid healing or reduce pain. Patches also cause visual disturbance, discomfort from the patch itself, reduced oxygenation and tearing, and a higher risk of infection. Michael and associates looked at patching versus nonpatching among children with corneal abrasions in a randomized clinical trial.
Children between three and 17 years of age with documented corneal abrasions that were confirmed with fluorescein, and who had no other acute eye pathology, were eligible for inclusion in the study. Patients randomly assigned to the patch group received one dose of erythromycin ophthalmic ointment before patch placement. The no-patch group was instructed to use the ointment three times a day until follow-up. All patients were instructed to use ibuprofen every six to eight hours as needed for pain and to use acetaminophen for breakthrough pain every four to six hours if it was too early for the next dose of ibuprofen.
Thirty-five of the 37 participants followed up with the ophthalmology clinic, and abrasion size, interference with activities of daily living (information obtained from the child or parent), pain medication diaries, absence from school, and any complications were evaluated. Among participants who were followed through the entire study, no difference was noted between the patch and no-patch groups in mean percent healing, pain assessments and use of analgesics, days of school missed, or complications, and no complications were reported in either group. The only activity of daily living that was significantly different was increased difficulty walking in the patched children.
The authors conclude that, as noted among adult patients, eye patching in children with corneal abrasion does not increase healing rates or reduce pain. There was some increased difficulty in walking among children with an eye patch. Studies with larger numbers of patients and younger children are needed to confirm these results and look for other complications of patching.