Treating socket discharge and discomfort: a crossover randomised trial of vitamin A ointment, low-dose steroid eyedrops and artificial tears.

PURPOSE: This study evaluated the effects of artificial tears, vitamin A ointment and low-dose steroid drops on chronic irritation and discharge in anophthalmic patients wearing ocular prostheses. It also aimed to identify patient subgroups that may benefit from specific regimens.

METHODS

This prospective, crossover randomised trial used a Williams design with 40 ocular prostheses wearing participants aged 16 years or older who experienced chronic discharge or discomfort.Each participant underwent four 2-week intervention periods: artificial tears, vitamin A ointment, low-dose steroids (fluorometholone) and no medication as a control, separated by 2-week washout periods. Visual analogue scale questionnaires assessed discharge and irritation frequency and severity. Data were analysed using linear mixed models with Bonferroni correction for multiple comparisons and subgroup analyses were descriptive.

RESULTS

In the total group, vitamin A ointment most consistently improved all outcome parameters: irritation frequency (-1.766, 95% CI (-2.857 to -0.675), p<0.001), irritation severity (-1.448, 95% CI (-2.564 to -0.332), p=0.004), discharge frequency (-1.186, 95% CI (-2.295 to -0.077), p=0.029) and discharge severity (-1.146, 95% CI (-2.177 to -0.114), p=0.021). Artificial tears significantly reduced irritation frequency (-1.279, 95% CI (-2.370 to -0.188), p=0.013). Fluorometholone showed no significant reduction in the total group. Individually, there was considerable variation among the outcomes, indicating that the optimal regimen differs between individuals.

CONCLUSIONS

Vitamin A ointment demonstrated the most consistent benefit in anophthalmic patients wearing ocular prostheses, whereas artificial tears and low-dose steroid drops were associated with clinically relevant improvement in a subset of individual patients with chronic irritation and discharge.