Key concepts

The clinician must be able to distinguish ophthalmic conditions that lead to significant morbidity, including blindness.

The choice of topical antibiotic in patients who wear contact lenses must cover Pseudomonas aeruginosa.

Both acute and chronic bacterial conjunctivitis are self-limiting, except if caused by staphylococci.

O1 Viral conjunctivitis is usually self-limiting, worsening after 4 to 7 days, but then resolving within 2 to 4 weeks.

Nonpharmacologic measures are critical to prevent the spread of viral conjunctivitis.

® Use a step-care approach for treatment of allergic conjunctivitis.

Untreated bacterial keratitis is associated with corneal scarring and potential loss of vision. Corneal perforation may cause the loss of the eye.

® There is no cure for age-related macular degeneration (AMD) and the efficacy of most treatments is low.

Dry eye is a chronic condition in which symptoms can be improved with treatment, but it is not usually curable. Patient education is critical.

INTRODUCTION

This chapter provides an overview of common ophthalmic disorders and their treatments. Many ophthalmic disorders are benign or self-limited, but the practitioner must be able to distinguish conditions that lead to serious morbidity, including blindness. Preserving both visual function and cosmetic appearance must be done whenever possible.1 The clinician must understand when referral is appropriate and the appropriate time frame for follow-up. These vary greatly by condition.

OCULAR EMERGENCIES

ETIOLOGY AND EPIDEMIOLOGY

Ophthalmic problems encompass 3% to 10% of all emergency department visits.1 Falls are a frequent cause of traumatic eye injury in the elderly. Corneal abrasions are the most common eye injury in children and are often due to fingernail scratches or objects swung near the eye. Even aggressive eye rubbing may damage the cornea. Accidental cigarette burns are common in children, but may be a sign of child abuse.3,4

Health care practitioners must know the proper treatment for ocular emergencies and the time frame for follow-up in order to prevent further morbidity (Table 63-1).

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