

8 y/o with eye pain and redness
Patient will present as → a 10-year-old boy who was hit in the right eye with a piece of bark that was thrown on the playground. He developed sudden onset of eye pain, photophobia, tearing, and blurring of vision. He claims there is "something stuck in my eye." On physical examination, there is significant 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
Question 1 |
Remove the eye patch | |
Prescribe haloperidol | |
Have the patient taken to the emergency room | |
Reassure the nursing staff and see the patient the next day |
Question 2 |
Ophthalmic antibiotics Hint: Ophthalmic antibiotics and copious irrigation are indicated when treating a patient with a suspected corneal ulcer due to an infectious cause. | |
Pressure patch | |
Examination for visual acuity Hint: Examination for assessment of visual acuity should be performed. | |
Copious irrigation Hint: See A for explanation. |
Question 3 |
Use a slit lamp to determine the extent of the injury. Hint: See C for explanation. | |
Use fluorescein strips to determine the extent of injury. Hint: See C for explanation. | |
Apply a metal eye shield and refer to an ophthalmologist. | |
Apply antibiotic ointment to the lid and recheck in 24 hours. Hint: See C for explanation. |
Question 4 |
increased intraocular pressure Hint: Elevated intraocular pressure is seen with glaucoma. | |
rust ring Hint: Rust ring is seen with metallic foreign bodies. | |
hazy cornea Hint: Hazy cornea is seen with glaucoma. | |
fluorescein uptake |
List |