Corneal Ulceration (ulcerative keratitis)- Infiltrate + epithelial defect + Anterior chamber reaction + Pain
< 24 hour ophtho followup
Intensive topical Antibiotics- differing opinions but a safe option is 1-2 drops into the affected eye every 15 minutes for the first two hours and then hourly until seen by ophthalmology.
NEVER patch a contact lens wearer for comfort as this can accelerate infection
The provider must stress the importance of strict adherence to the dosing protocol
Corneal Abrasion
urgent ophtho followup
treat aggressively as above if ulcer cannot be excluded.
fluroquinolones (4-8 times daily) and lens removal are reasonable if uncomplicated abrasion expected.
hypersensitivity
discontinue contact lens wear and prescribe preservative free drops
routine ophtho followup
Contact lens deposits, neovascularization, corneal warpage, Chronic epithelial changes, dry eye are all diagnoses of exclusion and should not be made definitively in the emergency department- refer to ophtho and treat aggressively if infection is suspected.
< 24 hour ophtho followup
Intensive topical Antibiotics- differing opinions but a safe option is 1-2 drops into the affected eye every 15 minutes for the first two hours and then hourly until seen by ophthalmology.
NEVER patch a contact lens wearer for comfort as this can accelerate infection
The provider must stress the importance of strict adherence to the dosing protocol
The provider must stress the importance of strict adherence to the dosing protocol
urgent ophtho followup
treat aggressively as above if ulcer cannot be excluded.
fluroquinolones (4-8 times daily) and lens removal are reasonable if uncomplicated abrasion expected.
discontinue contact lens wear and prescribe preservative free drops
routine ophtho followup
Contact lens problems
Contact lens wearers are at increased risk of:
Ophthalmology abbreviations
Infectious corneal infiltrate or ulceration
Tinnitus
bacterial
Corneal ulcer
Keratoconjunctivitis