IMPROVING THE MANAGEMENT OF CORNEAL INJURIES WITH THE INTRODUCTION OF A PROFORMA
Authors: Wilson A , Thomson JR 
Published: November 2016

Objectives & Background

Corneal abrasions are a common presentation to the ED accounting for up to 80% of ocular presentations. The gold standard evaluation as set out by ophthalmologists encompasses both specific points when taking a history and a comprehensive examination of the eye.

We aimed to audit our assessment and documentation of corneal abrasions within our ED before and after introducing a new proforma designed for corneal injuries.

Methods

We reviewed notes of 60 consecutive adult patients who presented with a corneal abrasion to the Emergency department between 1st August–17th October 2013 and again after introduction of the proforma from 1st October–19th December 2015.

Results

The audit highlighted that many aspects of management of corneal abrasions have been improved with the introduction of the proforma and that compliance with the majority of the key points required for gold standard management has risen. Table1.

Looking at key areas of history taking, documentation of contact lens use has improved from 23.3% to 73.3% and previous corneal injuries from 10% to 70%.

Documentation of examination also improved with use of the proforma. Clear diagrams detailing size and position of corneal abrasions increased from 33.3% to 78.3% and documentation of presence of corneal infiltrates from 1.6% to 68.3%. Eyelid eversion documentation improved from 58.3% to 75%.

Similar numbers of patients received chloramphenicol appropriately and an increased recognition of the need for analgesia was noted. A new information leaflet was introduced with clear information on expected course of injury and specific details on contact lens use and reasons to return. Its use has increased but still only 35% of patients were noted to have received it.

Interestingly there had been an increase in referrals made to the emergency eye clinic from 11.7% to 30%. 10 of these patients had no clear documentation of reason for referral and no high risk features indicating need for review.

The proforma was used in 58.3% of cases.

Conclusion

In conclusion the simple introduction of a specific proforma has greatly increased the efficacy of both documentation and management of the patient presenting with corneal abrasions.

Use of the proforma and PIL needs to be encouraged.

The benefit of similar proformas in other common presentations should be investigated.

Figure 1

Table 1

Audit Results

 % of cases ( N=60) Initial Audit (2013)Re-audit (2015) YesNoN/AYesNoN/AHistory      Enquiry into contact lens wear23.376.7–73.326.7–Enquiry into previous corneal abrasions10.090.0–70.030.0–Examination      VA recorded75.025.0–73.326.7–Lids everted58.341.7–75.025.0–Diagram in notes33.366.7–78.321.7–Documentation of presence/absence of infiltrate1.698.4–68.331.7–Management      Chloramphenicol 1% Ointment96.73.3–95.05.0–Oral analgesia15.085.0–45.055.0–Advice to avoid contact lenses1.73.395.013.36.780.0Advice leaflet20.080.0–35.065.0–Follow–up      Advice to return if symptoms persist or worsen66.721.711.753.316.730.0Discharged88.311.7–70.030.0–Referred to Eye Clinic11.788.3–30.070.0–Proforma used–––58.341.7–