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Am Fam Physician. 2004;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.

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

Email letter submissions to afplet@aafp.org. Letters should be fewer than 400 words and limited to six references, one table or figure, and three authors. Letters submitted for publication in AFP must not be submitted to any other publication. Letters may be edited to meet style and space requirements.

This series is coordinated by Kenny Lin, MD, MPH, deputy editor.

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