Please select the eligibility criteria that correspond to the clinical trial below.
Title: Challenging the Dogma: Topical Proparacaine is Safe and Effective for the Emergency Department Management of Acute Traumatic Corneal Injuries
Brief Summary: Introduction: Traumatic injuries to the outer covering of the eye (the cornea) are a common emergency department complaint. They cause significant patient distress including pain, loss of sleep and missed work days. There is currently no accepted, uniform approach to pain management in this patient population. Emergency medicine and ophthalmology texts state that prolonged use of medications that anesthetize the cornea is not recommended. Several recent publications in the ophthalmology literature show that the outpatient use of dilute local anesthesia in patients after eye surgery is a safe and effective method of pain control. In this study, we used Proparacaine (a local anesthetic), in a similar manner, for the outpatient emergency department management of traumatic corneal injuries.

Methods: We performed a clinical trial on a sample of adult patients presenting with traumatic corneal injuries to two university affiliated emergency departments in London, Canada.

Patients providing signed informed consent to participate in the study received a vial of clear liquid that contained either Proparacaine or plain water (placebo), a pain log, topical antibiotics and oral Acetaminophen (Tylenol) with Codeine for breakthrough pain.

Patients were instructed to use the "study drug" on an "as-needed" basis for the next seven days. Patients completed a pain scale describing their discomfort immediately prior to, and five minutes after self-administration of the study drug. All patients were followed closely in an ophthalmology outpatient clinic on Days 1, 3 and 5 after presentation to the emergency department. At the last ophthalmology clinic visit, the patients' pain logs were collected.

The protocol was approved by the Research Ethics Board for Health Sciences Research Involving Human Subjects at the University of Western Ontario.


Options:
A: 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
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:

* 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
D: 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).

Answer: C