Corneal abrasion: Difference between revisions
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==Clinical Features== | |||
#Foreign body sensation | |||
#Photophobia (+/- consensual) | |||
#Decreased vision | |||
##If associated iritis or if abrasion occurs in visual axis | |||
#Relief of pain with topical anesthesia | |||
##Virtually diagnostic of corneal abrasion | |||
==Diagnosis== | ==Diagnosis== | ||
#Visual acuity | #Visual acuity | ||
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##If yes then place eye shield and obtain emergent ophtho referral | ##If yes then place eye shield and obtain emergent ophtho referral | ||
#Contact lens wearer? | #Contact lens wearer? | ||
##If yes | ##If yes AND e/o white spot or opacity on exam concerning for infiltrate or ulceration ###Refer for same day ophtho appt | ||
#Fluorescein Examination | #Fluorescein Examination | ||
##Seidel sign (streaming of fluorescein caused by leaking aqueous humor) | ##Seidel sign (streaming of fluorescein caused by leaking aqueous humor) | ||
###Indicates penetrating trauma (globe microperforation) | ###Indicates penetrating trauma (globe microperforation) | ||
##Multiple vertical abrasions suggests foreign body embedded under the upper lid | |||
##Branching pattern suggests possible [[Herpes Zoster Ophthalmicus]] | ##Branching pattern suggests possible [[Herpes Zoster Ophthalmicus]] | ||
#[[Corneal Ulcer]]? | #[[Corneal Ulcer]]? | ||
##Grayish white | ##Grayish white | ||
##Worsening symptoms | ##Worsening symptoms >1day | ||
#Intraocular foreign body? | #Intraocular foreign body? | ||
##If concern for foreign body but none visualized on external exam consider CT orbit | ##If concern for foreign body but none visualized on external exam consider CT orbit | ||
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#Antibiotics - Indicated for all abrasions | #Antibiotics - Indicated for all abrasions | ||
##Ointment is better than drops due to its lubricant effect | ##Ointment is better than drops due to its lubricant effect | ||
###Erythromycin ointment qid x 3- | ###Erythromycin ointment qid x 3-5d | ||
##If treatintg contact lens associated abrasion must cover pseudomonas | ##If treatintg contact lens associated abrasion must cover pseudomonas | ||
### | ###Cipro/ofloxacin or tobramycin drops qid x 3-5d | ||
#Analgesia | #Analgesia | ||
##Cycloplegics | ##Cycloplegics | ||
###Consider for patients with large abrasions and | ###Consider for patients with large abrasions (>2mm) and/or severe pain | ||
####Cyclopentolate | ####Cyclopentolate 1% 1 drop q6-8hr | ||
##Systemic opiods | ##Systemic opiods | ||
##Never give Rx for topical anesthetics | ##Never give Rx for topical anesthetics | ||
#Tetanus prophylaxis | #Tetanus prophylaxis | ||
##Only indicated for penetrating injuries, not for abrasions or foreign bodies | ##Only indicated for penetrating injuries, not for abrasions or foreign bodies | ||
#Rust Ring | |||
##Treat similar to pts with corneal abrasions | |||
=== | ==Disposition== | ||
#Ophtho f/u in 48h | |||
# | |||
==Source== | ==Source== | ||
Revision as of 21:51, 26 October 2011
Clinical Features
- Foreign body sensation
- Photophobia (+/- consensual)
- Decreased vision
- If associated iritis or if abrasion occurs in visual axis
- Relief of pain with topical anesthesia
- Virtually diagnostic of corneal abrasion
Diagnosis
- Visual acuity
- If substantially subnormal evaluate for corneal edema versus infectious infiltrate
- Pupil shape and reactivity
- Irregular or nonreactive pupil suggests pupillary sphincter injury
- Evaulate for penetrating injury
- Irregular or nonreactive pupil suggests pupillary sphincter injury
- Hyphema or hypopyon?
- If yes then same same-day ophtho consult is required
- Hyphema suggests possible penetrating injury
- Extruded ocular contents?
- If yes then place eye shield and obtain emergent ophtho referral
- Contact lens wearer?
- If yes AND e/o white spot or opacity on exam concerning for infiltrate or ulceration ###Refer for same day ophtho appt
- Fluorescein Examination
- Seidel sign (streaming of fluorescein caused by leaking aqueous humor)
- Indicates penetrating trauma (globe microperforation)
- Multiple vertical abrasions suggests foreign body embedded under the upper lid
- Branching pattern suggests possible Herpes Zoster Ophthalmicus
- Seidel sign (streaming of fluorescein caused by leaking aqueous humor)
- Corneal Ulcer?
- Grayish white
- Worsening symptoms >1day
- Intraocular foreign body?
- If concern for foreign body but none visualized on external exam consider CT orbit
DDx
Foreign Body Removal Techniques
- Irrigation
- Cotton swab
- 18-25G needle
Treatment
- Antibiotics - Indicated for all abrasions
- Ointment is better than drops due to its lubricant effect
- Erythromycin ointment qid x 3-5d
- If treatintg contact lens associated abrasion must cover pseudomonas
- Cipro/ofloxacin or tobramycin drops qid x 3-5d
- Ointment is better than drops due to its lubricant effect
- Analgesia
- Cycloplegics
- Consider for patients with large abrasions (>2mm) and/or severe pain
- Cyclopentolate 1% 1 drop q6-8hr
- Consider for patients with large abrasions (>2mm) and/or severe pain
- Systemic opiods
- Never give Rx for topical anesthetics
- Cycloplegics
- Tetanus prophylaxis
- Only indicated for penetrating injuries, not for abrasions or foreign bodies
- Rust Ring
- Treat similar to pts with corneal abrasions
Disposition
- Ophtho f/u in 48h
Source
- UpToDate
- Tintinalli