Please select the eligibility criteria that correspond to the clinical trial below.
Title: Effect of Tetracaine on Pain Management and Corneal Healing in Patients With Acute Corneal Abrasion
Brief Summary: Corneal abrasions are associated with significant discomfort during a 24-48 hrs healing phase. Current practice guidelines discourage the use of topical anesthetics in treating these patients due to concerns that these medications may prevent proper corneal epithelial healing. These concerns are based primarily on decades old animal based research. However, recent evidence suggests topical anaesthetics are a safe and effective way of managing patient pain in the short term. This study will investigate the effect of topical 0.5% tetracaine on corneal healing and pain management in patients with corneal abrasions in the first 48 hours.

This will be a prospective, double blind, randomized, controlled study of 260 adults with uncomplicated acute corneal injuries presenting to the tertiary acute care settings in Kingston. Patients will be randomly assigned to receive either 0.5% tetracaine or saline in addition to usual care as outpatients. They will be followed through the ophthalmology emergency eye clinic to assess healing at 36-48hrs. after the acute care visit. The primary outcome will be an assessment of pain as measured every 4 hours for 48 hrs. using a 10mm Visual Analogue Scale (VAS). Secondary outcomes will include assessments of corneal healing, use of adjunct pain medications, time lost from work/usual activities, quality of sleep, ability to read and the SF12 quality of life questionnaire.

This study will better inform the safety and effectiveness of short-term tetracaine usage in patients with simple corneal abrasions for optimal treatment of patients in the future.


Options:
A: Inclusion Criteria:

* adult patients with acute (within 24 hrs) traumatic corneal injuries

Exclusion Criteria:

* immunocompromised
* known allergy to local anesthetic
* unable to consent /follow instructions for dosing / go to follow-up appointments
* previous ocular pathology
B: Inclusion Criteria:

* Patients (\>18yo) coming in with acute (\<24 hours) simple uncomplicated corneal abrasions.

Exclusion Criteria:

1. Patients with frankly contaminated wound, corneal foreign body, or epithelial defect secondary to contact lens wear
2. History of comorbid eye conditions including eye surgery within the past month and glaucoma.
3. Involvement of both eyes
4. Allergy to tetracaine or any of the substances used in the study
5. Unable to provide consent.
6. Unable to come for follow-up.
7. Patients with a past history of corneal injury infection or surgery will undergo a screening test of the corneal sensation. If a diminished or absent sensation is found, the patient will be excluded from the study.
C: Inclusion Criteria:

* All patients aged 18 years to 80 years old presenting to the ED with suspected acute corneal abrasion from mechanical trauma or removal of a foreign body by the physician were included

Exclusion Criteria:

* Patients were excluded if they wore contact lenses, had previous corneal surgery or transplant in the affected eye, presented more than 36 hours after their injury, had a grossly contaminated foreign body or coexisting ocular infection. Additional exclusion criteria were pregnancy, retained foreign body, penetrating eye injury, immunosuppression, allergy to study medication, inability to attend follow up, inability to fluently read and speak English or Spanish, or any injury requiring urgent ophthalmologic evaluation (large or complicated abrasions with significant vision loss, corneal ulcers, corneal lacerations).
D: Inclusion Criteria:

* Patients \> 18 years of age with a primary diagnosis of uncomplicated corneal abrasion presenting to NYMH emergency department

Exclusion Criteria:

* Patients\<18 years of age with complicated corneal abrasions or other eye injuries
* Present more than 36 hours after their initial injury
* Had previous eye surgery or cataracts
* Wear contact lenses or if their injury was caused from contact lens wear
* Had injured both eyes
* Unable to give informed consent
* Current infectious or chemical conjunctivitis
* Have a grossly contaminated foreign body in their eye
* Currently suffering from an ocular infection
* Currently or previously had herpes keratitis
* Allergies to tetracaine or similar medication classes
* Had an injury requiring urgent ophthalmologic evaluation; including penetrating eye injuries, large or complicated corneal abrasions, or injuries causing a significant disruption of visio)
* Unable to attend follow up in 48 hours

Answer: B