Difference between revisions of "Corneal abrasion"

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(Background)
(Analgesia)
Line 52: Line 52:
 
*Systemic [[NSAIDs]] or opioids
 
*Systemic [[NSAIDs]] or opioids
 
*Cycloplegics can be consider for patients with large abrasions (>2mm) and/or severe pain
 
*Cycloplegics can be consider for patients with large abrasions (>2mm) and/or severe pain
**Cyclopentolate 1% 1 drop q6-8hr
+
**[[Cyclopentolate]] 1% 1 drop q6-8hr
 
*Ophthalmic [[NSAIDs]]
 
*Ophthalmic [[NSAIDs]]
 
**[[Ketorolac]] 0.4% 1 drop q6hr x 2-3d
 
**[[Ketorolac]] 0.4% 1 drop q6hr x 2-3d

Revision as of 15:30, 3 April 2017

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
Corneal Abrasions from Airbag Deployment
Corneal Abrasions from Airbag Deployment

Differential Diagnosis

Unilateral Red Eye

^Emergent diagnoses

^^Critical diagnoses

Evaluation

  • A complete eye exam should be conducted
  • Eyelid Exam
    • Flip upper lid and exam lower lid for FB
    • If concern for FB despite normal exam, consider orbital CT or MRI is certain it is nonmetallic
  • Fluorescein Exam
    • Apply 1 gtt of flourescein or utilize strip with anesthetic
    • Use Wood's Lamp or Slit Lamp with colbalt blue light
    • Fluoresceine will fill corneal defects and glow
    • Multiple vertical abrasions suggests foreign body embedded under the upper lid

Additional Considerations

  • Contact lens wearer
    • If white spot or opacity on exam concerning for infiltrate or ulceration refer for same day ophtho appt
  • Fluorescein Examination
  • Visual acuity
    • If poor, consider corneal edema versus infectious infiltrate
  • Pupil shape and reactivity
    • Irregular or nonreactive pupil suggests pupillary sphincter injury and possible penetrating trauma
  • Hyphema or hypopyon
    • Hyphema suggests possible penetrating injury
    • If present then same same-day ophtho consult is required
  • Extruded ocular contents
    • If yes then place eye shield and obtain emergent ophtho referral
  • Corneal Ulcer
    • Grayish white lesion
    • Worsening symptoms >1day

Management

Antibiotics

Does Not Wear Contact Lens

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

  • Systemic NSAIDs or opioids
  • Cycloplegics can be consider for patients with large abrasions (>2mm) and/or severe pain
  • Ophthalmic NSAIDs
  • Topical anesthetics
    • Tetracaine 1% 1 drop q30min has been found to be safe in the first 24 hrs[1]

Other

  • Tetanus prophylaxis not indicated (unless penetrating injury)[2]
  • Patch is not routinely recommended[3] and can prolong healing time[4]

Disposition

  • Ophtho follow up in 48h for routine cases
  • Minor abrasions will heal in 48h

References

  1. Waldman N, et al. Topical tetracaine used for 24 hours is safe and rated highly effective by patients for the treatment of pain caused by corneal abrasions: a double-blind, randomized clinical trial. Acad Emerg Med. 2014; 21(4):374-82.
  2. Mukherjee P, et al. Tetanus prophylaxis in superficial corneal abrasions. Emerg Med J. 2003; 20:62-64.
  3. Flynn CA, et al. Should we patch corneal abrasions? A meta-analysis. J Fam Pract. 1998; 47(4):264-70.
  4. Fraser, S. Corneal abrasion. Clin Ophthalmol. 2010; 4:387-390.

See Also