MDT Eye Corneal Abrasion and Ulcer

Question 1

Corneal epithelium regenerates quickly, so healing time for abrasions is short, usually within how many hours?

Answer 1

24 to 48 Hours

Question 2

Patient has these issues what would you suspect?
(1) Severe pain, tearing and photophobia.
(2) History of trauma to the eye, commonly involving a foreign object (fingernail, piece of paper, or contact lens).

Answer 2

Corneal Abrasion

Question 3

Patient has these issues what Labs/studies would you perform?
(1) Severe pain, tearing and photophobia.
(2) History of trauma to the eye, commonly involving a foreign object (fingernail, piece of paper, or contact lens).

Answer 3

Slit lamp to identify dimensions of abrasion.

Question 4

Corneal Abrasion Differential Diagnosis:

Answer 4

(1) Conjunctival abrasion
(2) Subconjuctival hemmorrhage
(3) Foreign body

Question 5

Patient has these issues
(1) Severe pain, tearing and photophobia.
(2) History of trauma to the eye, commonly involving a foreign object (fingernail, piece of paper, or contact lens).

WHAT antibiotics would you order for a non-contact lens wearer?

Answer 5

Antibiotic ointment (e.g., erythromycin, bacitracin, or bacitracin/polymyxin B q2– 4h)
OR
Antibiotic drops (e.g., polymyxin B/trimethoprim or a fluoroquinolone)

Question 6

Patient has these issues
(1) Severe pain, tearing and photophobia.
(2) History of trauma to the eye, commonly involving a foreign object (fingernail, piece of paper, or contact lens).

WHAT antibiotics would you order for a contact lens wearer?

Answer 6

Fluoroquinolone drops

Question 7

Topical nonsteroidal anti-inflammatory drug (NSAID) drops for Corneal Abrasion

Answer 7

Ketorolac 0.4% to 0.5% q.i.d. for 3 days) for pain control

Question 8

Pain management for Corneal abrasion

Answer 8

Oral acetaminophen or NSAIDs

Question 9

True/False
Debride loose or hanging epithelium because it may inhibit healing

Answer 9

True

Question 10

True/False
Your Patient can continue to wear their contacts while healing from a corneal abrasion.

Answer 10

False
They should not wear contact lenses

Question 11

Corneal Abrasion Follow Up

Answer 11

(a) Follow up in 24 hours (or sooner if the symptoms worsen) for re-evaluation.
(b) Revisit every 3 to 5 days until healed.

Question 12

Corneal Abrasion Complications:

Answer 12

(1) Corneal ulcer
(2) Development of infection (Iritis)

Question 13

Corneal ulcer is also known as what?

Answer 13

Infectious keratitis

Question 14

What is the biggest risk factor for corneal ulcer

Answer 14

improper contact lens use

Question 15

Causative Organisms for Corneal ulcers
Bacteria:

Answer 15

Pseudomonas aeruginosa,
Streptococcus pneumoniae,
Staphylococcus species,
Moraxella species

Question 16

Causative Organisms for Corneal ulcers
Viruses

Answer 16

Herpes simplex
Varicella zoster

Question 17

Causative Organisms for Corneal ulcers
Fungi:

Answer 17

Candida,
Aspergillus,
Penicillium,
Cephalosporium

Question 18

_______ is a serious infection involving multiple layers of the cornea

Answer 18

Infectious keratitis/Corneal Ulcer

Question 19

Patient has these issues, what would you suspect
(a) Erythema and edema of lids and conjunctivae; discharge; ocular pain or foreign body sensation; photophobia; or blurred vision.
(b) Visual acuity is decreased if the ulcer is located in the central visual axis
(c) Cornea reveals a round or irregular opacity or infiltrate – classically central in location
(d) Severe cases may have hypopyon (white, hazy base - due to WBC infiltration)
(e) Fluorescein reveals staining epithelial defect

Answer 19

corneal ulcer

Question 20

Patient has these issues, what Antibiotics would you give?

(a) Erythema and edema of lids and conjunctivae; discharge; ocular pain or foreign body sensation; photophobia; or blurred vision.
(b) Visual acuity is decreased if the ulcer is located in the central visual axis
(c) Cornea reveals a round or irregular opacity or infiltrate – classically central in location
(d) Severe cases may have hypopyon (white, hazy base - due to WBC infiltration)
(e) Fluorescein reveals staining epithelial defect

Answer 20

1) Ciprofloxacin (Ciloxan) or Ofloxacin (Ocuflox) Ophthalmic drops
2) Fluroquinolone (Vigamox) Q1h.

Question 21

Treatment for Corneal Ulcer
True/False
Do not patch the eye because of the risk of Pseudomonas infection, which can cause rapid, aggressive ulceration with corneal melting and perforation.

Answer 21

TRUE
DO NOT PATCH THE DAMN EYE

Question 22

For a corneal Ulcer should you patch the EYE?

Answer 22

NO

Question 23

Why cant you patch the eye for a corneal Ulcer

Answer 23

the risk of Pseudomonas infection

Question 24

Complications for corneal ulcer

Answer 24

Corneal scarring, corneal perforation, development of anterior and posterior synechiae, glaucoma, and cataracts.

Question 25

True/False
You can manage a Corneal Ulcer as an IDC

Answer 25

FALSE
MEDIVAC
Refer to an ophthalmologist to be seen within 12 to 24 h.