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    Death of the pressure patch has been slightly exaggerated

     

    I’m much less certain of what’s going to happen to a bandage CL in those situations.

    It’ll probably fall out on its own, and life will go on.

    Or, it could end up as an irritating foreign body in the superior cul-de-sac, or even worse, remain on the cornea for too long and lead to a sight-threatening ulcer.

    4. Further mechanical insult

    With a pressure patch, the pads and tape can provide a barrier and extra measure of protection against finger or knuckle-to-eye rubbing.

    Related: Riding out conjunctivitis like a bad storm

    This can be a concern in pediatric and special-needs patients, older patients with dementia, or just absent-minded ones who reach up and start going at it before they realize what they’ve done.

    The future of pressure patching

    We’ve all learned over the years that less is more. A secure and effective patch doesn’t need a ton of eye pads and tape. No use in sending the patient home looking like King Tut with a six-inch proptosis like we did when we were students.

    My broader point is more philosophical than purely clinical, though.

    Best practice guidelines are just that—guidelines. They’re not religious dogma designed to herd everyone into the same line.

    We are rightly moving toward more evidence-based medicine, such as increased use of bandage lenses and less pressure patching in the management of corneal abrasions and erosions.

    But clinical intuition, developed through tens of thousands of patient encounters, enables a clinician to recognize exceptions to “the rule” and offer individualized care to each patient.

    Medicine is both art and science. When it comes to reasonable differences of opinion on treatment modalities, perhaps a little more humility would be good for all of us.

    I’m betting in a quieter and more reflective setting where he’s away from the bully pulpit and not temporarily lost in the enthusiasm of the moment, my lecturing colleague would say:

    Amen.

    Read more from Dr. Brown here

    Michael Brown, OD, FAAO
    Dr. Brown has practiced medical optometry in a comanagement center and with the U.S. Department of Veterans Affairs Outpatient Clinic in ...

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