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