PANCE Blueprint EENT (9%)

Corneal abrasion (ReelDx)

REEL-DX-ENHANCED-REGISTERED Corneal Abrasian Patient will present with →  history of mild trauma followed by sudden onset of eye pain, photophobia, tearing, foreign body sensation, blurring of vision, and/or conjunctival injection

  • Corneal abrasion is the most common ophthalmologic visit to the emergency department and is a commonly seen problem in urgent care.
  • Corneal abrasions most commonly result from accidental trauma (e.g., fingernail scratch, makeup brush): Dirt, sand, sawdust, or other foreign body gets caught under eyelid.

Diagnose with fluorescein staining - increased absorption in devoid area

Must be able to differentiate corneal abrasion from corneal ulcer – They will appear different on exam, ulcers often visible without fluorescein, abrasions will be seen on fluorescein often as thin line.

  • Topical anesthetic - immediate relief (do not dispense)
  • Treat with topical antibiotic ointment (preferable to drops) as lubrication will likely help.
  • Ophthalmic antibiotics include ciprofloxacin 0.3%, ofloxacin 0.3%, gentamicin 0.3%, erythromycin 0.5%, polymyxin B/trimethoprim (Polytrim), and tobramycin 0.3%
  • Patching for corneal abrasions is generally no longer recommended because it may delay corneal healing
  • Follow up daily, refer if large or central

Fluorescein staining is diagnostic for corneal abrasion

Fluorescein staining is diagnostic for corneal abrasion

Question 1
An 85-year-old nursing home patient was seen in a local physician’s office during the day for a corneal abrasion. The patient had antibiotic drops instilled, and the eye was patched. At 10: 00 p.m., the nursing staff calls reporting the patient is very confused. The most appropriate action is to
A
Remove the eye patch
B
Prescribe haloperidol
C
Have the patient taken to the emergency room
D
Reassure the nursing staff and see the patient the next day
Question 1 Explanation: 
Sensory deprivation, such as patching an elderly patient’s eyes, may lead to an acute case of delirium. Even small alterations in the elderly patient’s environment can lead to confusion. In cases of corneal abrasions, an elderly patient should receive topical ophthalmic antibiotics. Although eye patching traditionally has been recommended in the treatment of corneal abrasions, multiple well-designed studies show that patching does not help and may hinder.
Question 2
A 57 year-old male was working on his farm, when some manure was slung hitting his left eye. He presents several days after with a red, tearing, painful eye. Fluorescein stain reveals uptake over the cornea looking like a shallow crater. Which of the following interventions would be harmful?
A
Ophthalmic antibiotics
Hint:
Ophthalmic antibiotics and copious irrigation are indicated when treating a patient with a suspected corneal ulcer due to an infectious cause.
B
Pressure patch
C
Examination for visual acuity
Hint:
Examination for assessment of visual acuity should be performed.
D
Copious irrigation
Hint:
See A for explanation.
Question 2 Explanation: 
Patching of the eye after abrasion associated with organic material contamination is contraindicated due to increased risk of fungal infection.
Question 3
A 16 year-old male involved in a fight sustained a laceration to his right upper eyelid. He is unable to open his eye, and a possible laceration of the globe is suspected. Which of the following is the next step?
A
Use a slit lamp to determine the extent of the injury.
Hint:
See C for explanation.
B
Use fluorescein strips to determine the extent of injury.
Hint:
See C for explanation.
C
Apply a metal eye shield and refer to an ophthalmologist.
D
Apply antibiotic ointment to the lid and recheck in 24 hours.
Hint:
See C for explanation.
Question 3 Explanation: 
Protect the eye from any pressure with a rigid metal eye shield and refer for immediate ophthalmologic consultation. Avoid unnecessary actions that would delay treatment or cause further injury.
Question 4
A patient presents with the complaint of irritation of the left eye one day after gardening. He states "I think there is something in my eye." Which of the following findings is consistent with your suspected diagnosis?
A
increased intraocular pressure
Hint:
Elevated intraocular pressure is seen with glaucoma.
B
rust ring
Hint:
Rust ring is seen with metallic foreign bodies.
C
hazy cornea
Hint:
Hazy cornea is seen with glaucoma.
D
fluorescein uptake
Question 4 Explanation: 
Fluorescein dye uptake is diagnostic for corneal abrasion
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