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 textbooks^2,3 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.

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