Topical nonsteroidal anti-inflammatory drugs for corneal abrasions: meta-analysis of randomized trials.
OBJECTIVE
To determine the effectiveness of topical nonsteroidal anti-inflammatory drugs (NSAIDs) in traumatic corneal abrasions.


METHODS
This was a systematic literature review and meta-analysis of randomized clinical trials (RCTs). The following databases were searched: MEDLINE (1966-2004), EMBASE (1980-2004), and Cochrane Central Register of Controlled Trials and Database of Systematic Reviews (first quarter 2004). The structured search strategy included a RCT filter and the terms "cornea," "wounds and injuries," "trauma," "corneal diseases," "eye injuries," "anti-inflammatory agents, nonsteroidal" and specific trade names of topical NSAIDs. In addition, four journals in ophthalmology and emergency medicine were hand searched. Two authors independently reviewed citations from the literature searches. To be included, studies had to be RCTs evaluating topical NSAIDs in traumatic corneal abrasions. Trials were included regardless of language or whether they were unpublished or published. Exclusion criteria were corneal ulcers, nonrandomized studies, animal studies, or perioperative setting. Outcomes were pain scale scores at 24 hours and adverse effects. Two independent reviewers assessed four trial quality components: randomization, double blinding, reporting of withdrawals, and concealment of allocation. Weighted mean difference, using a random effects model, was calculated.


RESULTS
Of the 200 citations identified, 11 RCTs met inclusion criteria. Eight trials were identified from the MEDLINE search, two from the EMBASE search, and one from conference proceedings. Seven trials enrolled fewer than 100 patients, and more than half of the studies were conducted in Europe. Five trials reported suitable data for analysis. The overall weighted mean difference for 459 patients was a reduction in pain by 1.30 points (95% confidence interval = -1.56 to -1.03) on the pain scale. Five of the trials met criteria for good quality. Transient stinging was a commonly noted adverse effect.


CONCLUSIONS
Topical NSAIDs are effective analgesics for traumatic corneal abrasions.
Calder
Lisa Anne
LA
BScH, Department of Emergency Medicine, The Ottawa Hospital, Civic Campus, 1053 Carling Avenue, Ottawa, Ontario, Canada K1Y 4E9. lcalder@sympatico.ca
Balasubramanian
Sowmya
S
Fergusson
Dean
D
D000287:Administration, Topical; D000328:Adult; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000008:administration & dosage*; D065306:Corneal Injuries; D005131:Eye Injuries / Q000150:complications / Q000188:drug therapy*; D005260:Female; D006801:Humans; D008297:Male; D010146:Pain / Q000175:diagnosis / Q000188:drug therapy / Q000209:etiology; D016032:Randomized Controlled Trials as Topic; D016896:Treatment Outcome
D000894:Anti-Inflammatory Agents, Non-Steroidal