Patient Encounter 1

A 12-year-old boy presents with a swollen, watery left eye that he cannot open. His mom says he was outside playing when it happened. You question the boy and he says he was sword-fighting with long sticks and was poked in the eye. He says it feels as though a piece of stick might still be in the eye. He rubbed it hard to try and improve it but now it hurts to even open the eye.

What is the proper time frame for follow-up for this injury?

What are the desired outcomes for this patient?

What pharmacologic therapy might be used after the foreign body is removed?

• Tape the eyelids closed or use gels or soft contacts during general anesthesia to prevent lag-ophthalmos

• Carefully fit and place contact lenses Pharmacologic Therapy

Topical NSAIDs

Topical nonsteroidal anti-inflammatory drugs (NSAIDs) decrease pain from corneal abrasion. Available ocular NSAIDs are diclofenac 0.1%, ketorolac 0.5%, nepafenac 0.1%, and bromfenac 0.09%. The usual dose for diclofenac and ketorolac is one drop four times daily; nepafenac is dosed three times daily and bromfenac is dosed twice daily. Use topical NSAIDs with caution in patients with clotting disorders or those who are on systemic NSAIDs or warfarin therapy. Topical administration of NSAIDs

may delay wound healing, especially with concurrent topical corticosteroid use. Oral analgesics are not well studied for use in corneal abrasion; they may have decreased efficacy. They are less expensive than topical NSAIDs and may be an option for some patients.

Topical Antibiotics

Because an infection slows the healing of a corneal abrasion, prophylactic antibiotics are often used. Studies on the efficacy of this are mixed. Discontinue the use of contact lenses until the abrasion is healed and the antibiotic course complete.

In contact lens wearers, choose an antibiotic that covers Pseudomonas aeru-ginosa, like gentamicin ointment or solution or a fluoroquinolone. Antibiotic resistance is an increasing problem. Resistance occurs primarily with older antibiotics, but has been reported for fluoroquinolones as well. Two newer fluoroquinolones, gati-floxacin and moxifloxacin, do not yet have reports of resistance. These agents are more expensive.6

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