Corneal abrasion: Difference between revisions
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==Background== | |||
#Must rule-out intraocular foreign body and corneal laceration | |||
==Clinical Features== | ==Clinical Features== | ||
#Foreign body sensation | #Foreign body sensation | ||
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#[[Corneal Ulcer]] | #[[Corneal Ulcer]] | ||
#[[Herpes Zoster Ophthalmicus]] | #[[Herpes Zoster Ophthalmicus]] | ||
#Corneal laceration | |||
#Intra-ocular foreign body | |||
==Foreign Body Removal Techniques== | ==Foreign Body Removal Techniques== |
Revision as of 21:52, 26 October 2011
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 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