Eye Disorders Guideline - California Department of Industrial Relations

Eye Disorders

Effective Date: April 1, 2017

CONTRIBUTORS

Editor-in-Chief:

Kurt T. Hegmann, MD, MPH, FACOEM, FACP

Evidence-based Practice Eye Panel Chair:

Bernard R. Blais, MD, FAAO, FACOEM, FACS

Evidence-based Practice Eye Panel Members:

Panel members represent expertise in ophthalmology, optometry, occupational medicine, medical

toxicology (preventive medicine), and law. Identities are blinded for external peer-review.

Methodology Committee Consultant:

Kurt T. Hegmann, MD, MPH, FACOEM, FACP

Research Conducted By:

Kurt T. Hegmann, MD, MPH, FACOEM, FACP

Jeremy J. Biggs, MD MSPH

Kristine Hegmann, MSPH, CIC

Matthew A. Hughes, MD, MPH

Matthew S. Thiese, PhD, MSPH

Ulrike Ott, PhD, MSPH

Atim C. Effiong, MPH

Brenden Ronna

Leslie Cepeda Echeverria

Dillon Fix

Austen James Knudson

Jeremiah Lafayette Dortch

Zachary Cooper Arnold

Alzina Koric

Ninoska De Jesus

Katherine Anne Schwei

Louise Juliet

Specialty Society and Society Representative Listing:

ACOEM acknowledges the following organizations and their representatives who served as reviewers of

the ¡°Eye Disorders Guideline.¡± Their contributions are greatly appreciated. By listing the following

individuals or organizations, it does not infer that these individuals or organizations support or endorse

the eye treatment guidelines developed by ACOEM. An additional organization wished to remain

anonymous.

American Association of Occupational Health Nurses

Kim Olszewski, DNP, CRNP, COHN-S/CM, FAAOHN

American College of Emergency Physicians

Charles J. Gerardo, MD, MHS

Richard D. Shih, MD

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TABLE OF CONTENTS

Introduction ................................................................................................................................................ 51

Foreign Bodies, Rust Rings, and Corneal Abrasions ................................................................................ 179

Traumatic Injuries .................................................................................................................................... 253

Viral, Bacterial, and Fungal Infections and Corneal Ulcers ..................................................................... 269

Blepharoconjunctivitis ............................................................................................................................. 339

Allergic Disorders ..................................................................................................................................... 342

Atopic and Vernal Keratoconjunctivitis ................................................................................................... 454

Chemical Burns ......................................................................................................................................... 462

Thermal Burns .......................................................................................................................................... 499

Pterygium ................................................................................................................................................. 552

Appendix 1: Low-Quality Randomized Controlled Trials and Non-Randomized Studies ...................... 626

References ................................................................................................................................................ 650

SUMMARY OF RECOMMENDATIONS

Adenovirus Screening

Anesthetics, Topical

Adenovirus Screening, Routine Use for Infectious

Conjunctivitis

Not Recommended, Insufficient Evidence (I)

Adenovirus Screening, Select Patients for Infectious

Conjunctivitis

Recommended, Evidence (C)

Topical Anesthetics for Corneal Abrasions, Rust Rings,

and Foreign Bodies

Moderately Recommended, Evidence (B)

Antibiotics for Bacterial Conjunctivitis and Bacterial

Infections Complicating Corneal Ulcers

Moderately Recommended, Evidence (B)

Antibiotics for Blepharoconjunctivitis

Recommended, Insufficient Evidence (I)

Antibiotics for Viral Conjunctivitis

Not Recommended, Insufficient Evidence (I)

Prophylactic Ophthalmic Antibiotics for Organic

Matter Injuries

Recommended, Insufficient Evidence (I)

Prophylactic Ophthalmic Antibiotics for Simple Corneal

Abrasion, Rust Rings, and Foreign Bodies

No Recommendation, Insufficient Evidence (I)

Antifungal Medications for Fungal Conjunctivitis and

Fungal Infections Complicating Corneal Ulcers

Recommended, Evidence (C)

Antibiotics

Antifungals

Prophylactic Ophthalmic Antifungals for Routine

Prophylaxis of Simple Corneal Abrasions, Rust Rings,

and Foreign Bodies

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Not Recommended, Insufficient Evidence (I)

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High Molecular Weight Specific Antigens

Strongly Recommended, Evidence (A)

Low Molecular Weight Specific Antigens

Not Recommended, Insufficient Evidence (I)

Antihistamine and/or Mast Cell Stabilization

Medications for Allergic Diseases

Strongly Recommended, Evidence (A)

Artificial Tears or Lubrication for Chemical Ocular

Burns

Recommended, Insufficient Evidence (I)

Artificial Tears or Lubrication for Extensive Corneal

Abrasions, Rust Rings, and Foreign Bodies

Recommended, Insufficient Evidence (I)

Artificial Tears or Lubrication for Thermal Ocular Burns

Recommended, Insufficient Evidence (I)

Computed

Tomography

CT for Evaluation of Ocular Foreign Body and Possible

Orbital Fracture

Recommended, Insufficient Evidence (I)

Contact Lenses

Therapeutic Contact Lens for Corneal Abrasions, Rust

Rings, and Foreign Bodies

Not Recommended, Evidence (C)

Depth Perception Screening for Periodic Surveillance

Examinations

Recommended, Evidence (I)

Depth Perception Screening for Preplacement

Examinations

Recommended, Evidence (I)

Depth Perception Screening for Select Post-injury

Examinations

Recommended, Evidence (I)

Depth Perception Screening for Select Postoperative

Examinations

Recommended, Evidence (I)

Education for Allergic Conditions

Recommended, Insufficient Evidence (I)

Education for Potential Eye Injuries

Recommended, Evidence (C)

Epidermal Growth

Factor

Epidermal Growth Factor (EGF) for Corneal Abrasions,

Rust Rings, and Foreign Bodies

Not Recommended, Evidence (C)

Exposure Reduction

Management of Allergic Eye Symptoms without

Asthma (Reduction of Exposure)

Recommended, Insufficient Evidence (I)

Eye Patching for Chemical Ocular Burns

Recommended, Insufficient Evidence (I)

Eye Patching for Corneal Abrasion

Moderately Not Recommended, Evidence (B)

Eye Patching for Thermal Ocular Burns

Recommended, Insufficient Evidence (I)

Eye Patching for Welder¡¯s Flash

Not Recommended, Insufficient Evidence (I)

Foreign Body Removal

Foreign Body Removal of Superficial Foreign Body(Ies)

with Cotton Swab, Needle or Magnet

Recommended, Insufficient Evidence (I)

Not Recommended, Insufficient Evidence (I)

Glucocorticosteroids

Adjuvant Glucocorticosteroids for Bacterial

Conjunctivitis and Bacterial Infections Complicating

Corneal Ulcers

Glucocorticosteroid Drops for Chemical Ocular Burns

Recommended, Insufficient Evidence (I)

Antigens

Antihistamines

Artificial Tears

Depth Perception

Screening

Education

Eye Patching

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Glucocorticosteroid Drops for Inflamed Pterygia or

Pingueculae

Recommended, Evidence (C)

Glucocorticosteroid Eye Drops for Allergic Diseases

Recommended, Insufficient Evidence (I)

Glucocorticosteroids for Symptoms of Viral

Conjunctivitis

No Recommendation, Insufficient Evidence (I)

Gram Stain, Potassium Iodide (KOH) Preparation,

Culture and Sensitivity of Eye Infections (Routine)

Not Recommended, Insufficient Evidence (I)

Gram Stain, Potassium Iodide (KOH) preparation,

Culture and Sensitivity of Eye Infections (Select

Patients)

Recommended, Evidence (C)

IgG Specific Immunological Testing for High Molecular

Weight Specific Antigens

Not Recommended, Evidence (C)

Copious Irrigation for Chemical Eye Exposures

Recommended, Insufficient Evidence (I)

Copious Irrigation for Removal of Superficial Foreign

Body(ies)

Recommended, Insufficient Evidence (I)

Copious Irrigation for Thermal Eye Exposures

Recommended, Insufficient Evidence (I)

Irrigating Systems (e.g., Morgan Lens) for Chemical

Eye Exposures

Recommended, Insufficient Evidence (I)

Irrigating Systems (e.g., Morgan Lens) for Thermal Eye

Exposures

Not Recommended, Insufficient Evidence (I)

Lid Hygiene

Daily Lid Hygiene for Blepharoconjunctivitis

Recommended, Insufficient Evidence (I)

Magnetic Resonance

Imaging

MRI for Diagnosis of Foreign Body and Corneal

Abrasion

Not Recommended, Insufficient Evidence (I)

Bevacizumab for Prevention of Pterygia Recurrence

Recommended, Evidence (C)

Topical Aminocaproic Acid for Traumatic Hyphema

Moderately Recommended, Evidence (B)

Tranexamic Acid for Traumatic Hyphema

Recommended, Evidence (C)

Mydriatic Medications for Simple Corneal Abrasions,

Rust Rings, and Foreign Bodies

Moderately Not Recommended, Evidence (B)

Non-steroidal Anti-inflammatory Drugs for Symptoms

of Viral Conjunctivitis

Not Recommended, Evidence (C)

NSAID Drops after Removal of Rust Ring or Foreign

Body Removal

Moderately Recommended, Evidence (B)

NSAID Drops for Chemical Ocular Burns

Recommended, Insufficient Evidence (I)

NSAID Drops for Inflamed Pterygia or Pingueculae

Recommended, Evidence (C)

NSAID Drops for Thermal Ocular Burns

Recommended, Insufficient Evidence (I)

NSAID Drops for Welder¡¯s Flash

Recommended, Insufficient Evidence (I)

Gram Stain, KOH

Immunological Testing

Irrigation

Medications, Other

Mydriatic Medications

NSAIDS

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NSAID Eye Drops for Allergic Diseases

Moderately Recommended, Evidence (B)

Topical Opioids for Analgesia of Corneal Abrasions,

Rust Rings, and Foreign Bodies

Not Recommended, Evidence (C)

Protective Eyewear for Prevention of Eye Injuries

Recommended, Evidence (C)

Safety Glasses in Most Employment Settings

Recommended, Evidence (C)

Safety Goggles, Face Shields and/or Splash Guards in

High-Risk Jobs for Penetrating Eye Trauma or Chemical

Splashes

Recommended, Insufficient Evidence (I)

Rust Ring Removal

Removal of Rust Ring

Recommended, Evidence (C)

Slit Lamp

Use of Slit Lamp and Fluorescein Stain for Evaluation

and Diagnosis of Foreign Body and Corneal Abrasion

Recommended, Insufficient Evidence (I)

Surgery

Pterygium Excision for Pterygia

Recommended, Evidence (C)

Amniotic Membrane Transplantation for Chemical

Ocular Burns

Recommended, Evidence (C)

Amniotic Membrane Transplantation with Medical

Therapy for Thermal Ocular Burns

Recommended, Evidence (C)

Corneal Transplantation for Blindness or Other

Corneal Scarring/Defects after Chemical Eye Exposures

Strongly Recommended, Evidence (A)

Standalone Amniotic Membrane Transplantation for

Acute Ocular Burns

No Recommendation, Insufficient Evidence (I)

Color Vision Screening for Periodic Surveillance

Examinations

Recommended, Evidence (C)

Color Vision Screening for Preplacement Examinations

Recommended, Evidence (C)

Color Vision Screening for Select Post-injury

Examinations

Recommended, Evidence (I)

Color Vision Screening for Select Postoperative

Examinations

Recommended, Evidence (I)

Peripheral Vision Screening for Periodic Surveillance

Examinations

Recommended, Evidence (I)

Peripheral Vision Screening for Preplacement

Examinations

Recommended, Evidence (I)

Peripheral Vision Screening for Select Post-injury

Examinations

Recommended, Evidence (I)

Peripheral Vision Screening for Select Postoperative

Examinations

Recommended, Evidence (I)

Vision Screening for Periodic Surveillance

Examinations

Recommended, Evidence (C)

Opioids, Topical

Protective Eyewear

Transplantation

Vision Screening

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