Corneal Pain

Question 1

When should a pressure patch be avoided for a corneal abrasion

Answer 1

If the abrasion is from vegetable matter due to high risk of fungal infection
-also if thought to be infectious or from CL wear

If no infection is present, a BCL may be used

Question 2

Steroids and corneal defects

Answer 2

Should be avoided when there is an epi defect present due to side effects of delayed wound healing and increased risk of infection
-a topical ophthalmic steroid can be added after the epithelial defect as healed, if indicated

Question 3

Debridement and corneal abrasion

Answer 3

Indicated if there is loose or hanging epithelial tissue assoacited with a corneal abrasion, or if the abrasion is not healing well within the first 24-48 hours of treatment. Results in clean edges for epithelial resurfacing to occur

Question 4

Treatment of small corneal abrasions

Answer 4

Topical abx QID and PFAT QID to Q2H

Question 5

Treatment for large abrasions (>10mm)

Answer 5

BCL and topical abx, or a pressure patch with a topical abx ointment

Question 6

If you see a pseudodendrite x 5 weeks

Answer 6

It’s probably acanthamoeba

-pain and pseudodendrites

Question 7

Fungal keratitis

Answer 7

Most common type of corneal ulcer after a traumatic corneal injury, esp from vegetable matter. The most common culprits are aspergillus and fusarium; Candida albicans often occurs in eyes with chronic corneal disease or in immunocompromised patient. Presents with a gray white infiltrate with feathery edges and satellite infiltrates. Hypopyon may also be present,

Question 8

EKC

Answer 8

Subepi infiltrates. Additional signs include follicles on the palpebral conj, serous discharge, preauricular lymphadenopathy, Hx of recent URI, and pseudomembranes.
Tx with steroids

Question 9

Things about corneal abrasions

Answer 9

• Hx of trauma
• epi defect without infiltrate
• BCL and topical prophylactic abx
• never put BCL on CL wearer (increased infection)
• f/u 1-2 days
• at risk for RCE in future

Question 10

Infectious ulcer

Answer 10

• epi defect with infiltrate
• bac attacking=infectious
• most common bac is pseudomonas (-), and staph epi (+)
• tx=abx (tobramycin, FQs)

Question 11

Sterile ulcers

Answer 11

• infiltrate without epi defect
• bac hanging out with huge inflammation response=sterile
• tx=steroids

Question 12

Pseudomonas

Answer 12

One of the top causes of CL assocaited corneal ulcers

Mucopurulent discharge

Tx=tobramycin, besi,moxi, gati

Question 13

Fungal ulcer tx

Answer 13

Natamycin 5% Q1-2H while awake, with an ointment at night and a cycloplegic