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Eye shields are used to protect the eye from further injury when the integrity of the globe is compromised or potentially compromised. The best results are obtained when early repair of globe disruption occurs, before any contents leak out or change position.1,2 In contrast, eye patches are intended to prevent movement of the eyelid over an injured but intact cornea. Eye patching is often performed to protect the eye from bright light or to facilitate healing of a corneal abrasion. While there have been no substantial changes in the indications for eye shields and their method of application, eye patching has recently become controversial.

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Indications

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Patches are indicated for corneal injuries due to abrasions as well as to thermal, light, or chemical burns.3 Patches are believed to promote healing and provide pain relief by decreasing movement of the eyelid across the recovering cornea.3,4 Secondarily, patches block light in photophobic patients with ciliary spasm or reactive iritis due to a corneal injury.4–6

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Some of these assumptions have now been questioned. Patching is believed to decrease corneal oxygenation, increase temperature, and increase infection risk.5–7 Several trials have randomized patients with corneal abrasions to receive patching versus no patching.6–8 They have found no difference in pain scores or healing time for small abrasions less than 10 mm in diameter. There was a significant decrease in healing time for patched patients with abrasions greater than 10 mm in diameter. Therefore, patching is still recommended for those with large defects.6,7 More recently, soft contact lens bandages have been used for patients who must maintain binocular vision.8,9

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Contraindications

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Absolute contraindications to patching are corneal abrasions in patients due to the wearing of contact lenses because of the increased incidence of infection and more pathogenic bacteria harbored by contact lens wearers.6Any patient considered at risk for penetration or rupture of the globe should not be patched. Patching will increase intraocular pressure and may cause extravasation of the contents of the globe. Patients must be carefully assessed for the presence of corneal ulcers masquerading as abrasions.3 Patching of a corneal ulcer may place pressure on the ulcer and deepen the ulcer or perforate the cornea.

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Relative contraindications are related to abrasion size and individual patient needs. Small abrasions are felt to heal well without patching. Patients requiring the use of binocular vision may benefit from not patching.6,7 Patches that come loose and allow eyelid movement are more painful for patients than no patch.3,4 Contraindications to ophthalmoplegics used in conjunction with patches are patients with known glaucoma or narrow angles on physical examination.3 Paradoxically, the contraindication to contact lens bandages is an abrasion in a patient who was wearing contact lenses, again because of the risk of infection.10

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