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Prevention and treatment regimens for recurrent corneal erosion

In recurrent corneal erosion repeated episodes of breakdown of the corneal surface produce disabling eye symptoms and predispose the cornea (the transparent part at the front of the eye) to infection. Recurrent corneal erosions may happen after trauma to the cornea. Management may be required to prevent the recurrence of the erosions following corneal trauma or once the diagnosis is made, or both. Most episodes of recurrent corneal erosion resolve with simple medical therapy such as topical eye drops and ointment. When such simple measures fail or recurrences become too frequent, alternative treatment strategies are required. This review included seven trials with a total of 443 participants. The trials were conducted in Germany, People's Republic of China, Japan, Sweden and three in the UK. The quality of the trials was poor and the authors found the level of evidence insufficient for the development of management guidelines. There was limited evidence that oral tetracycline or topical prednisolone, or both, and excimer laser ablation, may be effective treatments for recurrent corneal erosion. More good‐quality randomised controlled trials are needed to guide the management of recurrent corneal erosion.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2013

Fact sheet: Small objects in the eye

In daily life, small things can easily get into the eye and cause wounds on the surface of the cornea (superficial wounds). “Corneal abrasion”: this is the medical term for scratches to the clear layer covering the eye. It feels like something is still there, even though the foreign object is gone and there is no visible scratch. Corneal abrasions usually heal completely within two or three days. In this fact sheet we will explain the steps you can take if something small gets stuck in your eye, and to help you decide when it is necessary to go straight to a doctor or hospital.

Informed Health Online [Internet] - Institute for Quality and Efficiency in Health Care (IQWiG).

Version: August 30, 2012

Antivirals, interferon, and débridement treatments for herpes simplex eye disease

Ocular herpes is a prevalent and recurrent eye infection. Without therapy, only one half of non‐complicated herpetic corneal surface infections resolve in two weeks. Several treatments, ranging from medications to superficial wiping, aim to shorten the course of herpetic infection of the corneal surface. This review provides evidence‐based guidance on the comparative effectiveness of interventions for herpes simplex virus (HSV) epithelial keratitis, by systematically analysing clinical trials from Europe, North America, Asia, Australia, and Africa. Corneal healing rates were examined during treatment with antivirals, interferon, or corneal surface débridement. The first topical nucleoside antiviral drugs, idoxuridine and vidarabine, were moderately effective but newer antiviral drugs such as trifluridine and acyclovir were better. Ophthalmic preparations of trifluridine, acyclovir, ganciclovir, and brivudine were nearly equivalently effective and allowed approximately 90% of treated eyes to heal within two weeks. In parallel with the development of nucleoside antiviral drugs, interferon, which is an antiviral protein of the immune defence system, was studied in trials that indicated effectiveness of topical formulations. Compared with antiviral treatment, the combination of interferon with a nucleoside antiviral agent seemed to facilitate early healing. Ocular allergic and toxic effects were infrequent and transitory. Before the introduction of antiviral drugs and interferon, the corneal surface was removed by physical scraping or chemical erosion, but evidence is lacking that establishes the efficacy and safety of physicochemical methods of débridement. The joint use of débridement and antiviral therapy promoted corneal recovery but was not better than single antiviral medications on corneal epithelial healing.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2011

Childhood Rhabdomyosarcoma Treatment (PDQ®): Health Professional Version

Expert-reviewed information summary about the treatment of childhood rhabdomyosarcoma.

PDQ Cancer Information Summaries [Internet] - National Cancer Institute (US).

Version: August 19, 2014

Referral Guidelines for Suspected Cancer in Adults and Children [Internet]

The guideline is divided into sections which cover in detail specific topics relating to twelve groups of cancers: lung, upper gastrointestinal cancers, lower gastrointestinal cancers, breast cancer, gynaecological cancers, urological cancers, haematological cancers, skin cancers, head and neck including oral cancers, brain/central nervous system cancers, bone and sarcoma, and children’s and young people’s cancers.

NICE Clinical Guidelines - Clinical Governance Research and Development Unit (CGRDU), Department of Health Sciences, University of Leicester.

Version: June 2005

Atopic Eczema in Children: Management of Atopic Eczema in Children from Birth up to the Age of 12 Years

Atopic eczema (atopic dermatitis) is a chronic inflammatory itchy skin condition that develops in early childhood in the majority of cases. It is typically an episodic disease of exacerbation (flares, which may occur as frequently as two or three per month) and remissions, except for severe cases where it may be continuous. Certain patterns of atopic eczema are recognised. In infants, atopic eczema usually involves the face and extensor surfaces of the limbs and, while it may involve the trunk, the napkin area is usually spared. A few infants may exhibit a discoid pattern (circular patches). In older children flexural involvement predominates, as in adults. Diagnostic criteria are discussed in Chapter 3. As with other atopic conditions, such as asthma and allergic rhinitis (hay fever), atopic eczema often has a genetic component. In atopic eczema, inherited factors affect the development of the skin barrier, which can lead to exacerbation of the disease by a large number of trigger factors, including irritants and allergens. Many cases of atopic eczema clear or improve during childhood while others persist into adulthood, and some children who have atopic eczema `will go on to develop asthma and/or allergic rhinitis; this sequence of events is sometimes referred to as the ‘atopic march’. The epidemiology of atopic eczema is considered in Chapter 5, and the impact of the condition on children and their families/caregivers is considered in Sections 4.2 and 4.3.

NICE Clinical Guidelines - National Collaborating Centre for Women's and Children's Health (UK).

Version: December 2007
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Primary Care Management of Abnormal Uterine Bleeding [Internet]

The Vanderbilt Evidence-based practice Center systematically reviewed evidence about interventions for symptomatic abnormal uterine bleeding (AUB), both irregular and cyclic. We focused on interventions that are suitable for use in primary care practice including medical, behavioral, and complementary and alternative medicine approaches.

Comparative Effectiveness Reviews - Agency for Healthcare Research and Quality (US).

Version: March 2013

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