Corneal abrasion: rx
Pretest
Question 1
True or false
For a corneal abrasion:
1. first evert the eyelid and scrutinize the palpebral conjunctiva, ocular surface and fornices to rule out the presence of foreign material.
2. Instill fluorescein dye to identify the corneal defects. Next, use the Seidel test (painting the wound with dye and observing for aqueous leakage) to uncover possible full-thickness injuries.
3. Document the size, shape, location and depth of the abrasion. Finally, evaluate the anterior chamber and perform a dilated fundus exam to check for other effects of the trauma.
4. Begin treatment with cycloplegia (atropine 1% for the worst cases, homatropine 5% for moderate cases and cyclopentolate 1% for the mildest) and a topical antibiotic such as Polytrim, gentamicin or tobramycin (Tobrex).
Question 2
True or false
For a corneal abrasion:
1. Recommend bed-rest, inactivity and OTC analgesics.
2. If pain is severe, prescribe a topical nonsteroidal anti-inflammatory (Voltaren, Acular or Ocufen, b.i.d. to q.i.d.) and/or a thin, low-water content bandage contact lens.
3. Today, pressure patching is somewhat controversial. When patients are not in a great deal of discomfort, most abrasions do not require patching. Larger abrasions may fare better with patching. The medicinal and homeostatic effects of patching help to keep patients still, quiet and more comfortable. Reevaluate the patient every 24 hours until the abrasion is re-epithelialized.
4. Bandage soft contact lenses have nearly supplanted the traditional pressure patch in the management of corneal abrasions.
Keyword
Treat recurrent erosions in much the same way. But bear in mind that, in this instance, larger defects may require patching. If pressure patching is unnecessary or contraindicated, prescribe a topical antibiotic drop q.i.d. with an antibiotic ointment at bed-time.
If the corneal epithelium is not healing properly within 24 to 48 hours, debride the area to give the epithelium a “clean slate” on which to regenerate. Instill a topical anesthetic, then remove the involved epithelium with a cotton-tipped applicator soaked in saline. Any of the above steps can be followed after the procedure.
The most severe, recalcitrant cases may require anterior stromal puncture (purposeful scarring of the involved area using a 23- to 25-gauge bent needle). This is accomplished by anesthetizing the cornea, then using the needle to puncture the epithelium to the levels of Bowman’s membrane or anterior stroma in the affected area.
The final step in managing recurrent erosions is hypertonic therapy. Sodium chloride drops and ointments (2% and 5%) applied to the eye q.i.d./q3h during the day and at bedtime will help to reduce corneal swelling, lubricate the corneal surface and promote epithelial adherence. Interestingly, they also may help to restore vision
http://www.revoptom.com/handbook/SECT3F.HTM
Question 1
TTTT
Question 2
TTTT