Yes, I individualize. One important criterion is patient's discomfort. Padding gives a great relief as it stops the persistent irritation from lid blinks.
Padding is not by itself at all beneficial, the theraputic part is the immobilization of the upper lid to prevent blinking from expanding the abraded area and to give the epithellum a chance to glide and grow to cover it, also prolonging the effect of the antibacterial topical medications that protect against secondary [nfection by minimizing the washing effect of blinking, and eleminate the pain from lid rubbing against exposed corneal nerve endings
Padding is not by itself at all beneficial, the theraputic part is the immobilization of the upper lid to prevent blinking from expanding the abraded area and to give the epithellum a chance to glide and grow to cover it, also prolonging the effect of the antibacterial topical medications that protect against secondary [nfection by minimizing the washing effect of blinking, and eleminate the pain from lid rubbing against exposed corneal nerve endings
completely agree
Eye padding is beneficial in case of corneal abrasion as it enhances the healing by preventing the blinking which can disturb the re-epithelialization of abraded cornea. It also decreases the pain which can occur due to rubbing against the raw area in the cornea.
Eye padding together with immobilization of lid are beneficial in case of corneal abrasion by preventing the blinking and decreasing the pain.
We use bandage contact lenses in most minor abrasions these days. Protects the cornea and also will hold the antibiotics longer.
Eye patching with pads for corneal abrasions are generally suggested or indicated as others have pointed out. Probably the most and immediate concern is to relieve the moderate to severe pain that the abrasion may result in. This temporarily and may slightly relieve the corneal pain due to the exposure of its naked nerve endings present in the epithelium. The primary reason why the cornea is a highly pain sensitive structure.
This also allows the corneal epithelium to grow over the defect without being re-abraded by the upper lid palpebral conjunctiva when blinking. It may result in its faster healing but if healing is sluggish or stagnant, a pressure eye patching with 2 pads may help as this further immobilizes or limits eyeball movements while affording the pegging of the epithelium to the corneal Bowman's membrane and stroma. This may be seen in abrasions caused by nails of your fingers where there may be a failure of attachments of the basal membrane's hemidesmosomes, collagen plaque attachments, fibronectin and laminin.
It may also be a good idea to use antibiotic eye drops to prevent infection of the abrasion site. A static antibiotic may be used for prophylaxis particularly important is that it should have a low toxicity potential.
Somehow most the abrasions may last for 1-3 days but if the epithelial abrasion is big and/or deep it may take several days, at the most 7 days (the turnover rate of the corneal epithelium). If so the eye pads may be maintained for 2-3 weeks. If this fails to correct the problem, then bandage contact lenses which are made up of thin hydrogels with a high Dk value may be indicated for the same period of time.
It must however be noted that the eye is clear of infection at the onset of eye patching. The eye pads preferably be sterile and be checked daily or when replaced for yellowish to greenish discharge. Once an infection is present eye patching should not be done since this will serve to make this closed system into a incubating space with the wetness and temperature for the microbe to multiply. This closed system also prevents the washing off of microbes from the eye to the excretory part of the lacrimal apparatus. .
The use of patching for corneal abrasion can be beneficial, but outdated. Far better is the use of therapeutic bandage soft contact lens, such as the disposable type available in a wide variety of sizes from various manufacturers. Almost every patient can be temporarily fit with 8.3-8.6 base curve in a low power(+ or- 0.50), allowing comfort, epithelial protection with rapid healing and use of binocular vision. This also allows use of topical antibiotics if the clinical situation dictates, as well as topical NSAID if needed, for additional analgesia
I agree to Mark Disclafani, that patching may help but is no longer the therapy of choice in most centers.
I also would recommend the use of therapeutic bandage soft contact lens
In my esperience contact lenses are netterei in terms of abrasion healing and visual performance s for the patient, sometimes patients (older in particolare way) do not change the patch causing more bacterial presence in the surrounding skin.
I prefer bandage contact lenses to eye pad patch for sterile abrasions and I always use with a topical antibiotic. If there is any concern for and infectious or dirty wound, no contact lens and no bandage is possible.
Yes with a topical ointment, age is important for me to prefer CL....
In a developing country like mine, eye padding remains more beneficial eventhough its outmoded to some extent. Its less expensive than therapeutic bandage CL, but during treatment patients have to be seen everyday for close monitoring and prevent infection.
When patients can afford cost of contact lens then its benefits over-rides eye padding.
Eye padding is what we still do for corneal abrasions as bandage contact lenses are not easily available or affordable to our patients. We usually pad after instilling a broad spectrum antibiotic ointment. The resulta have been good so far.
I prefer the eye padding as the best treatment although in some patient i used the contact lens
Personally, the decision to pad or not might depend on degree of abrasion and the need to limit pain caused by repeated blinking.
Is anyone aware of any RCT comparing the two options?
Sydney, that's interesting but what was the success rate of that particular method of treatment as you mentioned earlier on this page?
Padding is a very effective and efficient treatment for corneal abrasions. It helps with the healing and also alleviates the pain that the patient is most likely to suffer in the firs 24 to 48 hours of the abrasion. It is very important however that the padding is done right. If the eye is open under the pad or can blink, it will make the condition worse or be very uncomfortable. For sunken eyes a folded pad may need to be placed over the closed eyelids and then another pad on top of that firmly stuck down with millipore tape or a bandage.
A bandage contact lens is also effective. The risk of secondary infection, especially if one sleeps with the contact lens in the eye (as one would do with a lens on a abrasion) is known to increase the risk of infection by 11 to 15 times. This can be dangerous. Hence it is important to use preservative antibiotic drop prophylaxis with the lens in situ.
Shutting the eye with a pad also can increase risk of infection as it reduces the protective tear secretion and raises the temperature of the surface of the eye encouraging growth of commensal bacteria.
Neither a bandage contact lens nor a pad should be used in the presence of an eye discharge.
Harminder S Dua
Cornea and Ocular surface disease specialist.
Padding has been very effective throughout my 20 years in practice although it will be wise to have an RCT to compare the two methods. This will provide ground for best practices and quality patient care.
In my opinion padding is a very effective and efficient treatment for corneal abrasions. It helps with the healing and also alleviates the pain that the patient is most likely to suffer in the firs 24 to 48 hours of the abrasion. It is very important however that the padding is done right. If the eye is open under the pad or can blink, it will make the condition worse or be very uncomfortable. Padding is a very effective and efficient treatment for corneal abrasions. It helps with the healing and also alleviates the pain that the patient is most likely to suffer in the firs 24 to 48 hours of the abrasion. It is very important however that the padding is done right. If the eye is open under the pad or can blink, it will make the condition worse or be very uncomfortable. For sunken eyes a folded pad may need to be placed over the closed eyelids and then another pad on top of that firmly stuck down with millipore tape or a bandage.
A bandage contact lens is also effective. The risk of secondary infection, especially if one sleeps with the contact lens in the eye (as one would do with a lens on a abrasion) is known to increase the risk of infection by 11 to 15 times. This can be dangerous. Hence it is important to use preservative antibiotic drop prophylaxis with the lens in situ.
Shutting the eye with a pad also can increase risk of infection as it reduces the protective tear secretion and raises the temperature of the surface of the eye encouraging growth of commensal bacteria.
Neither a bandage contact lens nor a pad should be used in the presence of an eye discharge.
Shutting the eye with a pad also can increase risk of infection as it reduces the protective tear secretion and raises the temperature of the surface of the eye encouraging growth of commensal bacteria. NEVER patch in case of infection suspect. At the same time i have read the paper evaluating corneal defect healing time in patched and non-patched gropus of patients and concluded that it was no difference between the groups.
I think that the use of bandage or padding for 24 -48 hours in corneal abrasions is very hellpfull and very confortable for the patient . It hellps on healing process and also alleviate the disturbance and the pain caused by lights and blinking .
I think that if abrasion occurs in a large area of cornea, it is better to have eye padding. however, in small degrees of abrasion, it is not necessary to patch eye. eye padding has advantage and disadvantage. A tight patching may help for perfect treatment and prevents the recurrence of lesion but it also may cause eye to be contaminated especially in a humidity whether.
I do not think we have comparable effective options aside eye padding especially for corneal abrasions that interfere with vision as healing is spontaneous. If the abrasion is a small punctate one, then simple use of antibiotics and sunglasses would do for at least 48 hrs if padding would interfer with subjects occupation. The use of SiH soft CLs have been advocated, but the risk of complications resulting from non-compliance from pxs, and overnight lens use cannot be ruled out. It requires so much caution to use that.
Wy don't people use a single dose of topical NSAIDs . Very effective and your patients appreciate it
Some meta-analyses have found that there occurs no improvement as such, in the severity, or magnitude of pain on a pain scale, and also no improvement was appreciated in the rate of healing. This is in sharp contrast to the earlier belief that pain is reduced by reducing blinking and decreased eyelid induced trauma to the eye i.e., padding helps decrease blinking rate…and eye movements..and one of the studies also found that patch caused pain.. And most importantly, patching decreases oxygen levels around the cornea, increases moisture and also a higher chance of infection..(The above is from one or two published papers which I don’t remember and is extracted from one of my personal copies. If I get the original file, I will paste the link)(No plagiarism intended and I respect the view of authors).
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