Vision should return to normal in that time although ointment antibiotic formulations may cause and an iatrogenic decrease in vision.Ĭontact lens wearers who present with a corneal epithelial defect should be examined with the penlight to look for a corneal infiltrate, which is a white spot or opacity, or an ulcer, representing a surface breakdown, thinning, or necrosis that occurs in an area of infiltration. Most corneal abrasions heal regardless of therapy in one to three days. If a cycloplegic agent is going to be utilized, cyclopentolate is a good choice because of its short duration of action. There are side effects to cycloplegics, such as difficulty with reading. Like the opiate medications, two days of cycloplegic drops should be enough to manage the photophobia. A two days oxycodone prescription should be adequate.Ĭycloplegic medications can relieve photophobia. In the few patients with small abrasions that fail to heal despite these treatments, oral opioid medications may be required. Ophthalmic topical NSAID solutions provide pain relief. Mild to moderate pain can typically be controlled with oral nonsteroidal anti-inflammatory drugs (NSAIDs). Regarding pain control, small abrasions (less than 4 mm) rarely require analgesia. Never use topical corticosteroids due to delayed healing and increased risk of infection. Continued symptoms beyond three days warrant evaluation by an ophthalmologist. Duration of therapy is variable, but a patient can discontinue therapy entirely if the eye is symptom-free for 24 hours. Aminoglycoside antibiotics should be avoided in non-contact lens-wearing patients. Drops are available for sulfacetamide 10%, polymyxin/trimethoprim, ciprofloxacin, or ofloxacin. Erythromycin ointment is to be used four times daily for five days for non-contact lens-wearing patients. Contact lens wearers will need coverage for Pseudomonas with a fluoroquinolone or aminoglycoside. Ointment formulations provide lubrication to the injured eye. If the metal instrument fails, then an ophthalmology referral within 24 hours is needed for foreign body removal. Initiate topical antibiotics (erythromycin). A 25-gauge needle or an eye spud can be used to remove the object. If irrigation or a cotton swab fails to remove the foreign body, a metal instrument is needed. Foreign bodies under the lid should be removed after flipping the lid. If a corneal foreign body is detected, an attempt can then be made to remove the foreign body with a swab or irrigation under direct visualization. Tetanus prophylaxis is only necessary for penetrating eye injuries not simple corneal abrasions. Patching was previously routine but is no longer recommended for most patients. The administration of topical antibiotics and, for large abrasions, cycloplegics have been the mainstay of therapy, along with daily follow-up until the eye is healed. Herpes keratitis has dendritic dye uptake and requires immediate treatment. Foreign bodies on the inner eyelid typically cause vertical linear corneal lesions therefore, everting the eyelids is necessary to assess for foreign bodies. If a patient wears contact lenses, the abrasion may have several punctate lesions that coalesce into a round, central defect.
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Traumatic corneal abrasions typically have linear or geographic shapes. The dye appears green under cobalt blue light. The fluorescein dye passes over normal cornea tissue but gets stuck in any cornea defects. Apply a drop of a topical anesthetic into the eye or on a fluorescein strip and then apply it to the conjunctiva. Document extraocular movements.įluorescein staining helps identify a corneal epithelial defect. Significant decreases in visual acuity require referral to an ophthalmologist. Abrasions over the center of the cornea will cause a decrease in visual acuity. The presence of hyphema or hypopyon requires an immediate ophthalmologic referral. Inspect the anterior chamber for hyphema or hypopyon. A hazy cornea is a sign of edema from excessive rubbing. The conjunctival injection is typically present. A corneal opacity or infiltrate may occur with corneal ulcers or infection. Topical anesthetics are helpful to facilitate the examination. An abnormally shaped pupil could be a sign of globe rupture.