TO THE EDITOR: We read with great i...

TO THE EDITOR: We read with great interest the article "Prevention and Treatment of frequent Eye Injuries in Sports," (1) in the April 1 2003 issue of American Family Physician. Overall, we fix it to be a concise and informative article. However, in Table 3 the authors state that "24-hour ophthalmologic follow-up is mandatory" in the treatment of corneal abrasions. (1) It has been our experience that uncomplicated corneal abrasions may be followed up appropriately according to the primary care physician in the clinic, exigency department, or urgent care facility.

Although a brief literature review set up various and differing recommendations for follow-up we were not able to find any evidence (i.e., original outcome-based research) supporting these recommendations. pair of the most popular sudden [i]or[/i] unexpected occurrence medicine text-books (2,3) recommend 24-hour follow-up for patients with corneal abrasions on the contrary do not specify that this must be manner of lifeed by an ophthalmologist. A leading ophthalmologic textbook4 also does not commend or mandate ophthalmologic follow-up.

A close attention (5) of practices in Great Britain noted that solely 50 to 60 percent of follow-up was performed by the agency of the ophthalmologic house officer. In their conclusion, they recommend that "general practitioners play an increasingly active part in the diagnosis, treatment and follow-up of patients." (5)

In summary, while there is consensus that next-day follow-up is necessary for patients with corneal abrasions, evidence is lacking to support the ne for mandatory 24-hour ophthalmologic follow-up Our business is that by making as it was a strong statement, these authors' may be contributing to the creation of a novel "standard of care" without providing supporting evidence. The consensus appears to be that referral to an ophthalmologist is not indicated in the absence of complicating factors.

LEO BUNUEL-JORDANA, DO

DAVID C FIORE, MD

University of Nevada educate of Medicine

Department of Family and Community Medicine

Brigham Building, M 316

Reno, NV 89557

References

(1) Rodriguez JO Lavina AM, Agarwal A. Prevention and treatment of public eye injuries in sports. Am Fam Physician 2003;67:1481-8

(2) Marx JA, Hockberger R Walls RM Adams J ed Rosen's unforeseen occasion medicine: concepts and clinical practice. 5th ed St. Louis: Mosby, 2002:915-6.

(3) Tintinalli JE Kelen GD Stapczynski J ed sudden [i]or[/i] unexpected occurrence medicine: a comprehensive study guide. 5th ed New York: McGraw-Hill, Health Professions Division, 2000:1508-9

(4) Albert DM Jakobiec FA, ed Principles and practice of ophthalmology: clinical practice. Vol 5 Philadelphia: WB Saunders, 1994:3384-5

(5) Sabri K Pandit JC Thaller VT Evans NM Crocker GR National overlook of corneal abrasion treatment. inspection 1998;12:278-81.

EDITOR'S NOTE: This note was sent to the authors of "Prevention and Treatment of belonging to all Eye Injuries in Sports," who declined to reply

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