corneal

Question 1

signs of corneal abrasion

Answer 1

Vary according to severity of trauma
Lid oedema and erythema
Conjunctival hyperaemia
Corneal epithelial defect (stains with fluorescein)
Corneal oedema beneath defect
Visual loss (due to epithelial disruption and stromal oedema)
Possible secondary anterior uveitis (circumcorneal [ciliary] injection, cells, flare)

Question 2

symptoms of corneal abrasion

Answer 2

sudden onset
ranges from mild foreign body sensation to severe pain; may be disproportionate to objective findings
absence of pain should alert to possibility of neurotrophic keratitis
Blepharospasm
Blurred vision
Photophobia
Lacrimation
Redness
hx of trauma

Question 3

management of corneal abrasion

Answer 3

determine cause and size and depth and oedema and FB
- large abrasions bandage cls or refer to HES
- do not patch eye
- anaesthetic eg proxy for exam if needed
- systemic analgesia for first 24 hours if needed eg paracetamol or ibuprofen
- ocular lubricants, ointment for bedtime
- large epithelial defects, cycloplegia 1%, 2x a day till healed to prevent ciliary spasm
- possible infection then broad spectrum antibiotic chloramphenicol ointment 3x a day 5 days

Question 4

corneal abrasion - what if cls wearer (IP)

Answer 4

need something as antibiotic prophylaxis and gram neg
eg quinolone like levofloxacin 5mg/ ml or moxifloxacin or an aminoglycoside like gentamicin
cls not worn during tx

Question 5

corneal abrasion IP treatment

Answer 5

topical NSAID for analegesic and anti inflam properties eg diclofenac 0.1% QDS- not strong evidence but still used by some
- deep or contaminated refer to HES same day

Question 6

when to review corneal abrasions

Answer 6

1-2 days

Question 7

what if pregnant or allergic to chloramphenicol - corneal abrasion

Answer 7

supply Fucidic acid 1% liquid gel twice a day for 5 days

Question 8

corneal erosion management - intial

Answer 8

bandage cls
ocular lubricants preservative free, night ointment for 3months at least
padding eye doesn’t enhance management

Question 9

corneal erosion - severe cases

Answer 9

Antibiotic ointment, Chloramphenicol 1% eye ointment 3 times daily for 5 days
If allergic to Chloramphenicol, or pregnant, supply Fucidic acid 1% liquid gel twice a day for 5 days
Cyclopentolate 1% 3 times daily for 5 days, to prevent pupil spasm

Question 9

corneal erosion - in cases where where not responding (IP)

Answer 9

12 week trial of oral tetracycline