Chloramphenicol In Corneal Abrasions Study

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Chloramphenicol is the commonest ophthalmic antibiotic ointment used by non-ophthalmologists in current practice. It is prescribed by general practitioners and emergency physicians in all cases of corneal abrasions, regardless of severity or mechanism of injury. However, there has been no evidence to determine whether chloramphenicol is the optimum therapeutic agent to treat corneal abrasions. It is uncertain whether the therapeutic effect of chloramphenicol is the antimicrobial agent (decreasing microbial infiltration) or the lubricating ointment (preventing micro-abrasions and speeding corneal re-epithelialization). Further, given the widespread use of chloramphenicol as a first line therapy for uninfected injuries, a serious risk and a major concern is the development of chloramphenicol resistant bacterial species. Thus the purpose of this study is to explore whether a simple lubricating ointment is a viable alternative to chloramphenicol ointment in the treatment of corneal abrasions. If proven correct, this study could potentially revolutionize the treatment of corneal abrasions, significantly decreasing the risk of antibiotic resistant bacteria while providing a cheaper alternative for both patient and hospital. We aim to conduct a double-blinded randomized control trial comparing chloramphenicol to a lubricating ointment with no antimicrobial properties. Both ointments will be prepared within the Pharmacy Department of Westmead Hospital (unblinded member). The labels for both ointments will be masked and each ointment will be placed in individually numbered envelopes. When a patient with a corneal abrasion presents to the emergency department at Westmead Hospital a detailed ocular examination would be undertaken. If the patient meets our inclusion criteria and informed consent is obtained, the medical officer treating the patient would be provided with a numbered envelope dictated by a randomized matrix and the masked ointment dispensed. The patient would be discharged home with an information leaflet and instructions for use of the ointment. After 2 days, the patient will be asked to represent to the emergency department for follow-up by a specialist trained by the Department of Ophthalmology to detect signs of infection, side effects to treatment and appropriate corneal re-epithelialization and healing. If any signs of infection are noted, the patient will be referred to the Westmead Eye Clinic to be seen by an ophthalmologist on the same day. The results from this study will be entered into a database and analysed by statisticians with the intension of publishing our findings in international peer-reviewed journals.

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