Corneal abrasion
Revision as of 07:17, 28 November 2014 by Rossdonaldson1 (talk | contribs) (Rossdonaldson1 moved page Corneal Abrasion and Foreign Body to Corneal abrasion and foreign body)
Background
- Must rule-out intraocular foreign body and corneal laceration
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
- Corneal Ulcer
- Herpes Zoster Ophthalmicus
- Corneal laceration
- Intra-ocular foreign body
Foreign Body Removal
- Anesthetize eye
- Irrigate with NS
- Moistened cotton swab
- 25G needle
- Approach from tangential angle
Treatment
Antibiotics
- If treatintg contact lens associated abrasion must cover pseudomonas
Does Not Wear Contact Lens
- Erythromycin ointment qid x 3-5d OR
- Ciprofloxacin 0.3% ophthalmic solution 2 drops q6 hours OR
- Ofloxacin 0.3% solution 2 drops q6 hours OR
- Sulfacetamide 10% ophthalmic ointment q6 hours
Wears Contact Lens
Antibiotics should cover pseudomonas and favor 3rd or 4th generation fluoroquinolones
- Levofloxacin 0.5% solution 2 drops ever 2 hours for 2 days THEN q6hrs for 5 days OR
- Moxifloxacin 0.5% solution 2 drops every 2 hours for 2 days THEN q6hrs for 5 days OR
- Tobramycin 0.3% solution 2 drops q6hrs for 5 days OR
- Gatifloxacin 0.5% solution 2 drops every 2 hours for 2 days THEN q6hrs for 5 days OR
- Gentamicin 0.3% solution 2 drops six times for 5 days
Analgesia
- Cyclopentolate 1% 1 drop q6-8hr
- Cycloplegics can be consider for patients with large abrasions (>2mm) and/or severe pain
- Systemic opiods
- Never give Rx for topical anesthetics
- Tetanus prophylaxis
- Only indicated for penetrating injuries, not for abrasions or foreign bodies
Rust Rings
- Not necessary to remove in the ED; refer to ophtho for definitive removal
Disposition
- Ophtho f/u in 48h for routine cases
- Ophtho f/u in 24h for rust ring removal
Source
- UpToDate
- Tintinalli