Evidence-based emergency medicine. Update: do ophthalmic nonsteroidal anti-inflammatory drugs reduce the pain associated with simple corneal abrasion without delaying healing?
BACKGROUND
Some studies have suggested that ophthalmic nonsteroidal anti-inflammatory drugs (NSAIDs) decrease the pain associated with corneal abrasions without impairing healing. This evidence-based emergency medicine (EBEM) critical appraisal reviews the literature, including additional studies appearing since the publication of an earlier EBEM review in 1999.


METHODS
The updated search for randomized controlled trials from 1999 to 2002 complemented the previous 1966 to 1999 search. The methodologic quality of the studies was assessed. Qualitative methods were used to summarize the study results.


RESULTS
The search identified 3 studies not included in the previously published review of ophthalmic NSAIDs, yielding a total of 5 blinded, randomized, placebo-controlled trials involving NSAIDs for corneal abrasions. The methodologic quality of the new studies was somewhat higher than that of the 2 original studies and was rated as "good" to "strong." The qualitative summary indicates that NSAIDs provide greater pain relief and improvement of other subjective symptoms when compared with placebo. However, whether the reduction of pain, as measured by visual analog pain scales, exceeds the minimal clinically significant difference is equivocal. The use of ophthalmic NSAIDs may decrease the need for sedating analgesics.


CONCLUSIONS
Ophthalmic NSAIDs appear to be useful for decreasing pain in patients with corneal abrasions who can afford the medication and who must return to work immediately, particularly where potential opioid-induced sedation is intolerable.
Weaver
Christopher S
CS
Department of Emergency Medicine, Indiana University School of Medicine, Indianapolis, IN 46202, USA. chsweave@iupui.edu
Terrell
Kevin M
KM
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000700:Analgesics / Q000627:therapeutic use; D000900:Anti-Bacterial Agents / Q000008:administration & dosage / Q000627:therapeutic use; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000627:therapeutic use*; D065306:Corneal Injuries; D004008:Diclofenac / Q000627:therapeutic use; D004311:Double-Blind Method; D004338:Drug Combinations; D004635:Emergency Medicine; D019317:Evidence-Based Medicine; D005129:Eye Foreign Bodies / Q000628:therapy; D005131:Eye Injuries / Q000188:drug therapy*; D005500:Follow-Up Studies; D005839:Gentamicins / Q000008:administration & dosage / Q000627:therapeutic use; D006801:Humans; D007213:Indomethacin / Q000008:administration & dosage / Q000627:therapeutic use; D020910:Ketorolac / Q000008:administration & dosage / Q000627:therapeutic use; D008875:Middle Aged; D015337:Multicenter Studies as Topic; D009883:Ophthalmic Solutions; D010146:Pain / Q000175:diagnosis / Q000188:drug therapy*; D010147:Pain Measurement; D017288:Pain Threshold; D010919:Placebos; D016032:Randomized Controlled Trials as Topic; D013997:Time Factors; D016896:Treatment Outcome; D014945:Wound Healing
D000700:Analgesics; D000900:Anti-Bacterial Agents; D000894:Anti-Inflammatory Agents, Non-Steroidal; D004338:Drug Combinations; D005839:Gentamicins; D009883:Ophthalmic Solutions; D010919:Placebos; D004008:Diclofenac; D007213:Indomethacin; D020910:Ketorolac