What is the aim of this review?
This Cochrane Review aimed to find out whether ocular (given in the eye) antibiotics treatment can prevent eye infection following a corneal abrasion. We collected and analyzed all relevant studies to answer this question and found two studies.
Key messages
We could not find evidence that compared antibiotics with placebo (dummy treatment) or no treatment. We could not find enough evidence to support the use of one antibiotic over another to prevent eye infections with corneal abrasion.
What is a corneal abrasion?
The cornea is the transparent, protective outer layer of the eye. Corneal abrasion is a scratch of the cornea, usually caused by mechanical trauma, a foreign object in the eye, chemical burns, or contact lenses.
How is corneal abrasion managed?
Corneal abrasion causes pain and irritation, so treating physicians prescribe painkillers to help ease the pain. Some physicians may also prescribe antibiotics to prevent eye infections.
What did we want to find out?
We wanted to find out whether antibiotics could prevent eye infections following corneal abrasion.
What did we do?
We searched the medical literature for studies that tested antibiotics to prevent eye infection following a corneal abrasion.
What did we find?
We found two randomized controlled trials (studies where participants are randomly assigned to one of two or more treatment groups) with a total of 527 children and adults. One study in Denmark tested topical gels of chloramphenicol (a type of antibiotic) and fusidic acid (another type of antibiotic) (frequency was not clearly reported). The other study used a three-day course of ocular gel combinations of chloramphenicol (an antibiotic) and clotrimazole (an antifungal medication) or chloramphenicol and placebo (all three times daily) in India.
In the Danish study, the proportion of participants who recovered from corneal abrasion and had no infection was similar between groups. However, this study reported that one-third of participants in each treatment group experienced itching and discomfort of the eye.
The authors of the Indian study reported that 1% of participants experienced minor adverse events such as irritation and mild swelling of the eyelids and eye surface, and immunological reaction at the site.
We did not find any study that compared antibiotics with placebo or no treatment.
What does the evidence mean?
Due to a lack of robust evidence, we do not know whether the use of antibiotics can prevent eye infections in people with corneal abrasion or whether one antibiotic is better than another for this purpose.
How up-to-date is the evidence?
The evidence is current to 25 April 2021.
Given the low to very low certainty of the available evidence, any beneficial effects of antibiotic prophylaxis in preventing ocular infection or accelerating epithelial healing following a corneal abrasion remain unclear. Moreover, the current evidence is insufficient to support any antibiotic regimen being superior to another. There is a need for a well-designed RCT assessing the efficacy and safety of ocular antibiotics in the treatment of corneal abrasion with a particular focus on high-risk populations and formulation of interventions.
Corneal abrasion is a common disorder frequently faced by ophthalmologists, emergency physicians, and primary care physicians. Ocular antibiotics are one of the management options for corneal abrasion. A comprehensive summary and synthesis of the evidence on antibiotic prophylaxis in traumatic corneal abrasion is thus far unavailable, therefore we conducted this review to evaluate the current evidence regarding this important issue.
To assess the safety and efficacy of topical antibiotic prophylaxis following corneal abrasion. Our objectives were 1) to investigate the incidence of infection with antibiotics versus placebo or alternative antibiotics in people with corneal abrasion; and 2) to investigate time to clinical cure, defined as complete healing (re-epithelialization) of the epithelium, with antibiotics versus placebo or alternative antibiotics in people with corneal abrasion.
We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (which contains the Cochrane Eyes and Vision Trials Register; 2021, Issue 4), Ovid MEDLINE, Embase.com, PubMed, the Latin American and Caribbean Health Sciences Literature database (LILACS), ClinicalTrials.gov, and the World Health Organization (WHO) International Clinical Trials Registry Platform (ICTRP). We did not use any date or language restrictions in the electronic search for trials. We last searched the electronic databases on 25 April 2021.
We included randomized controlled trials (RCTs) comparing antibiotic with another antibiotic or placebo in children and adults with corneal abrasion due to any cause.
We used standard Cochrane methodology and assessed the certainty of the body of evidence for the prespecified outcomes using the GRADE classification.
Our search of the electronic databases yielded 8661 records. We screened 7690 titles and abstracts after removal of duplicates. We retrieved 32 full-text reports for further review. We included two studies that randomized a total of 527 eyes of 527 participants in the review. One study was conducted in Denmark, and one was conducted in India.
The two studies did not examine most of our prespecified primary and secondary outcomes. The first study was a parallel-group RCT comparing chloramphenicol ocular ointment with fusidic acid ocular gels (frequency was not clearly reported). This study enrolled 153 participants older than 5 years of age with corneal abrasion in Denmark with a one-day follow-up duration. No participants had secondary infection in the fusidic acid group, whereas three (4.1%) participants in the chloramphenicol group had a slight reaction (risk ratio [RR] 0.15, 95% confidence interval [CI] 0.01 to 2.79; 144 participants; very low certainty evidence). Thirty-one (44.3%) participants in the fusidic acid arm and 34 (46.6%) participants in the chloramphenicol arm were cured (defined as the area of abrasion zero and no infection) at day 1 (RR 0.94, 95% CI 0.65 to 1.34; 144 participants; very low certainty evidence). Without providing specific data, the study reported that the degree of pain was not affected by the interventions received. The most common adverse events reported were itching and discomfort of the eye, which occurred in approximately one-third of participants in each group (low certainty evidence).
A second multicenter, two-arm RCT conducted in India enrolled 374 participants older than 5 years of age with corneal abrasion who presented within 48 hours after injury. This study investigated the effect of a three-day course of either ocular ointment combinations of chloramphenicol-clotrimazole or chloramphenicol-placebo (all three times daily). At day 3, 169 (100%) participants in the chloramphenicol-clotrimazole arm and 203 (99%) out of 205 participants in the chloramphenicol-placebo arm were cured without any complication, defined as complete epithelialization of the cornea without evidence of infection (RR 1.01, 95% CI 0.99 to 1.03; 374 participants; very low certainty evidence). Four participants assigned to the chloramphenicol-placebo arm experienced mild adverse events: two participants (1%) had mild chemosis and irritation, and two (1%) had small single sterile corneal infiltrates (low certainty evidence).