Except in those cases when they don’t.
Because he wasn’t interested in hearing what those might be, I’ll share a few scenarios in which I might still reach for the tape and eye pads instead of a blister pack—in a non-COPE–approved kind of way, of course.
1. Large, deep epithelial defects
If an abrasion or erosion is small and shallow enough, and the patient isn’t too uncomfortable, I often choose to simply prescribe appropriate topical meds and not use a bandage lens or a patch.
Still, there are defects that are so bad the lid just needs to be immobilized to make the patient comfortable and jump-start the healing process.
Sometimes these come into the office ready-made, and others I create myself when I debride loose strands and flaps of damaged epithelium (Whoa, so that’s what a limbus-to-limbus defect looks like).
After that first big day of re-epithelialization, I might follow with a bandage CL to finish out the period of healing and prevent recurrent erosion.
Yes, I’m aware of the risk of infection in a “warm, moist environment,” but with close follow-up and modern antibiotics, it’s still relatively low.
Exceptions: Contact lens abrasions (and some cases of abrasions from fingernails or vegetative matter).
These patients get a bandage CL or go without cover with an appropriate broad spectrum topical antibiotic and perhaps a short course of a topical nonsteroidal anti-inflammatory drug (NSAID) as an adjunct to cycloplegia for pain control.
2. Lack of patient tolerance and/or contraindications
Surprise, surprise, you aren’t going to be able to apply a CL on all patients.
Some patients can’t stand the idea of having a “foreign object” in their eyes. Syncope on top of everything else, anyone?
For others, the lid swelling and hyper-lacrimation are so severe that attempting to apply a CL is an exercise in futility.
And really, don’t you hesitate just a little in putting a CL on the eye of a patient with severe chronic blepharoconjunctivitis and iffy personal hygiene?
3. No-shows for follow-up
This is a clear and present danger in my practice. There’s usually a better than even chance that one of my patients, for a variety of reasons, is going to be “one and done.”
I’m confident that patients who don’t return for follow-up will reach up, remove a pressure patch, and most likely use the topical meds that I’ve already prescribed for them—at least for a few days.