Corneal ulcer: Difference between revisions
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==Evaluation== | ==Evaluation== | ||
*Gray/white corneal lesion (will have fluorescein uptake) | |||
*Requires careful physical exam as 40% of lesions < 5mm | |||
*Hypopyon may be present | |||
*Iritis signs may be present (miotic pupil, Consenual photophobia) | |||
==Management== | ==Management== | ||
*Emergent ophtho consultation | *Emergent ophtho consultation | ||
*Topical antibiotics | *Topical antibiotics | ||
**[[Ciprofloxacin]] | **Vigamox 1 drop qhour '''OR''' | ||
* | **[[Ciprofloxacin]] 1 drop qhour | ||
*Cycloplegic | *Consider antiviral or anti-fungal if high suspicion for viral or fungal cause (rare) | ||
*Cycloplegic may help if iritis present | |||
**[[Cyclopentolate]] 1% | **[[Cyclopentolate]] 1% | ||
*Do not patch the eye | *Do not patch the eye | ||
==Disposition== | ==Disposition== | ||
*Discharge with ophtho followup within 24-48 hours | |||
==Complications== | ==Complications== | ||
*Corneal scarring | *Corneal scarring | ||
*Corneal perforation | *Corneal perforation | ||
* | *Anterior/posterior synechiae | ||
*Glaucoma | *Glaucoma | ||
*Cataracts | *Cataracts | ||
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==References== | ==References== | ||
<references/> | <references/> | ||
[[Category:Ophthalmology]] | [[Category:Ophthalmology]] | ||
Revision as of 08:33, 12 April 2019
Background
- Major cause of impaired vision and blindness worldwide
- Break in epithelial layer allows infectious agents to gain access to the underlying stroma
- Risk factors include: incomplete lid closure (e.g. secondary to Bell’s palsy) and soft contact lenses use (especially sleeping in contacts)
Causes
Clinical Features
- Redness and swelling of lids and conjunctiva
- Ocular pain or foreign body sensation
- Decreased visual acuity (if located in central visual axis or uveal tract is inflamed)
- Photophobia
Differential Diagnosis
Unilateral red eye
- Nontraumatic
- Acute angle-closure glaucoma^
- Anterior uveitis
- Conjunctivitis
- Corneal erosion
- Corneal ulcer^
- Endophthalmitis^
- Episcleritis
- Herpes zoster ophthalmicus
- Inflamed pinguecula
- Inflamed pterygium
- Keratoconjunctivitis
- Keratoconus
- Nontraumatic iritis
- Scleritis^
- Subconjunctival hemorrhage
- Orbital trauma
- Caustic keratoconjunctivitis^^
- Corneal abrasion, Corneal laceration
- Conjunctival hemorrhage
- Conjunctival laceration
- Globe rupture^
- Hemorrhagic chemosis
- Lens dislocation
- Ocular foreign body
- Posterior vitreous detachment
- Retinal detachment
- Retrobulbar hemorrhage
- Traumatic hyphema
- Traumatic iritis
- Traumatic mydriasis
- Traumatic optic neuropathy
- Vitreous detachment
- Vitreous hemorrhage
- Ultraviolet keratitis
^Emergent diagnoses ^^Critical diagnoses
Evaluation
- Gray/white corneal lesion (will have fluorescein uptake)
- Requires careful physical exam as 40% of lesions < 5mm
- Hypopyon may be present
- Iritis signs may be present (miotic pupil, Consenual photophobia)
Management
- Emergent ophtho consultation
- Topical antibiotics
- Vigamox 1 drop qhour OR
- Ciprofloxacin 1 drop qhour
- Consider antiviral or anti-fungal if high suspicion for viral or fungal cause (rare)
- Cycloplegic may help if iritis present
- Do not patch the eye
Disposition
- Discharge with ophtho followup within 24-48 hours
Complications
- Corneal scarring
- Corneal perforation
- Anterior/posterior synechiae
- Glaucoma
- Cataracts