HEENT MDT

Question 1

Abrasion Tx?

Answer 1

*Cyclopentolate 1% one
*contact lens abrasion: Tobramycin ophthalmic ointment. NO patch/ ophthalmic fluoroquinolone
*Not contact wear abrasion: erythromycin ointment Q6H, optional eye patch
*Organic source: erythromycin ointment. No patch. Ophthalmology referral or reexamine the next day

Question 2

Abrasions related to the wearing of soft contact lens common infection

Answer 2

pseudomonas infection

Question 3

Change in visual acuity in the affected eye. Fluorescent staining reveals a deeper green area than the surrounding cornea. Photophobia with examination. Increased lacrimation

Answer 3

Abrasion

Question 4

Abrasion studies?

Answer 4

Slit lamp to identify dimensions of abrasion.

Question 5

Abrasion complications

Answer 5

(1) Corneal ulcer

(2) Orbital cellulitis

(3) Loss of vision to the affected eye

Question 6

Corneal Abrasion DDx

Answer 6

Conjunctival abrasion
Subconjuctival hemmorrhage
Foreign body

Question 7

Use before staining eye?

Answer 7

a drop of topical anesthetic (e.g., proparacaine 0.5% or tetracaine 0.5%) may be added to facilitate examination if the patient is in pain or if it will be necessary to touch the cornea or conjunctiva

Question 8

Eye Foreign body general considerations

Answer 8

1. A visual acuity should be tested before treatment as a basis for comparison in the event of complications.
2. Steel foreign bodies may leave a rust ring which can be toxic to the corneal tissue

Question 9

Physical Findings:
*Red eye with predominantly circumcorneal injection (enlargement of the ciliary and conjunctival blood vessels near the margin of the cornea with reduction in size peripherally)

*Purulent or watery discharge

Cornea is a hazy appearance with a central ulcer and adjacent stromal abscess

Hypopyon (accumulation of white blood cells/whitish fluid layer lower portion of the eye’s anterior chamber)

Essentials of Diagnosis:
Pain
Photophobia
Tearing and reduced vision
Improper contact lens wears especially overnight use
Recent refractive surgery

Answer 9

Corneal Ulcer

Question 10

Corneal Ulcer The pathogens most commonly isolated:

Answer 10

-Pseudomonas aeruginosa
-Pneumococcus
-Moraxella species
-Staphylococci.

Question 11

Corneal Ulcer DDX:

Answer 11

Herpes simplex keratitis
Corneal abrasion
Ocular foreign body

Question 12

Corneal ulcer Tx

Answer 12

AMAL: Flouroquinolone/Moxifloxacin 0.5% (preferable med because they are also active against mycobacteria)
-1 drop Q1H/day, Q2H/ night for 48 hours, gradually reduce
- 1 drop Q8H for 7 days.

Gram-positive Cocci -cefazolin 10%
gram-negative bacilli -tobramycin 1.5%.

topical corticosteroids should be prescribed by ophthalmologist
Discontinue use of contacts
Address pain (NSAIDs)
Frequent re-exam until MedEvac

Question 13

Corneal ulcer Dispositoin, Complications, Waiver

Answer 13

Disposition:
Refer emergently to an ophthalmologist

Complications:
Corneal scarring
Intraocular infection

Waiver:
Recurrent corneal ulcers are disqualifying (physical standards)

Question 13

Abrasions related to the wearing of soft contact lens common infection

Answer 13

pseudomonas infection

Question 14

Abrasions related to the wearing of soft contact lens common infection

Answer 14

pseudomonas infection

Question 14

Ocular foreign body DDx

Answer 14

Dry eyes
Ultraviolet Keratitis
Corneal abrasion

Question 15

Abrasions related to the wearing of soft contact lens common infection

Answer 15

pseudomonas infection

Question 17

Abrasions related to the wearing of soft contact lens common infection

Answer 17

pseudomonas infection