Diferencia entre revisiones de «Corneal laceration»
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==Management== | ==Management== | ||
''See [[globe rupture]] for full thickness lacerations.'' | |||
===Antibiotics=== | |||
{{Corneal Abrasion Antibiotics}} | |||
===[[Analgesia]]=== | |||
*Systemic [[NSAIDs]] or [[opioids]] | |||
*[[Cycloplegic]]s can be consider for patients with large abrasions (>2mm) and/or severe pain | |||
**[[Cyclopentolate]] 1% 1 drop q6-8hr | |||
*Ophthalmic [[NSAIDs]] | |||
**[[Ketorolac]] 0.4% 1 drop q6hr x 2-3d | |||
*Topical anesthetics | |||
**[[Tetracaine]] 1% 1 drop q30min has been found to be safe in the first 24 hrs<ref>Waldman N, et al. Topical tetracaine used for 24 hours is safe and rated highly effective by patients for the treatment of pain caused by corneal abrasions: a double-blind, randomized clinical trial. Acad Emerg Med. 2014; 21(4):374-82.</ref> | |||
**Proparacaine 0.05% ophthalmic (dilute 1 mL of proparacaine 0.5% with 9 mL of NS in flush syringe then place 3 mL in bottle) 1-2 drops in eye Q30 min PRN pain for 24-48 hours only<ref>Salim Rezaie, "Topical Anesthetic Use on Corneal Abrasions", REBEL EM blog, April 21, 2014. Available at: https://rebelem.com/topical-anesthetic-use-corneal-abrasions/.</ref> | |||
===Other=== | |||
*[[Tetanus prophylaxis]] not indicated (unless penetrating injury)<ref>Mukherjee P, et al. Tetanus prophylaxis in superficial corneal abrasions. Emerg Med J. 2003; 20:62-64.</ref> | |||
*Patch is not routinely recommended<ref>Flynn CA, et al. Should we patch corneal abrasions? A meta-analysis. J Fam Pract. 1998; 47(4):264-70.</ref> and can prolong healing time<ref>Fraser, S. Corneal abrasion. Clin Ophthalmol. 2010; 4:387-390.</ref> | |||
==Disposition== | ==Disposition== | ||
Revisión del 19:47 29 may 2024
Background
- Common traumatic injuries to the eye, most often associated with penetrating injury or impact with debris.[1]
- If full-thickness, are open globe injuries that are a medical emergency
Clinical Features
Differential Diagnosis
Unilateral red eye
- Nontraumatic
- Acute angle-closure glaucoma^
- Anterior uveitis
- Conjunctivitis
- Corneal erosion
- Corneal ulcer^
- Endophthalmitis^
- Episcleritis
- Herpes zoster ophthalmicus
- Inflamed pinguecula
- Inflamed pterygium
- Keratoconjunctivitis
- Keratoconus
- Nontraumatic iritis
- Scleritis^
- Subconjunctival hemorrhage
- Orbital trauma
- Caustic keratoconjunctivitis^^
- Corneal abrasion, Corneal laceration
- Conjunctival hemorrhage
- Conjunctival laceration
- Globe rupture^
- Hemorrhagic chemosis
- Lens dislocation
- Ocular foreign body
- Posterior vitreous detachment
- Retinal detachment
- Retrobulbar hemorrhage
- Traumatic hyphema
- Traumatic iritis
- Traumatic mydriasis
- Traumatic optic neuropathy
- Vitreous detachment
- Vitreous hemorrhage
- Ultraviolet keratitis
^Emergent diagnoses ^^Critical diagnoses
Evaluation
Workup
Diagnosis
Management
See globe rupture for full thickness lacerations.
Antibiotics
Does Not Wear Contact Lens
- Erythromycin ointment qid x 3-5d OR
- Ciprofloxacin 0.3% ophthalmic solution 2 drops q6 hours OR
- Ofloxacin 0.3% solution 2 drops q6 hours OR
- Sulfacetamide 10% ophthalmic ointment q6 hours
Wears Contact Lens
Antibiotics should cover pseudomonas and favor 3rd or 4th generation fluoroquinolones
- Levofloxacin 0.5% solution 2 drops ever 2 hours for 2 days THEN q6hrs for 5 days OR
- Moxifloxacin 0.5% solution 2 drops every 2 hours for 2 days THEN q6hrs for 5 days OR
- Tobramycin 0.3% solution 2 drops q6hrs for 5 days OR
- Gatifloxacin 0.5% solution 2 drops every 2 hours for 2 days THEN q6hrs for 5 days OR
- Gentamicin 0.3% solution 2 drops six times for 5 days
Analgesia
- Systemic NSAIDs or opioids
- Cycloplegics can be consider for patients with large abrasions (>2mm) and/or severe pain
- Cyclopentolate 1% 1 drop q6-8hr
- Ophthalmic NSAIDs
- Ketorolac 0.4% 1 drop q6hr x 2-3d
- Topical anesthetics
- Tetracaine 1% 1 drop q30min has been found to be safe in the first 24 hrs[2]
- Proparacaine 0.05% ophthalmic (dilute 1 mL of proparacaine 0.5% with 9 mL of NS in flush syringe then place 3 mL in bottle) 1-2 drops in eye Q30 min PRN pain for 24-48 hours only[3]
Other
- Tetanus prophylaxis not indicated (unless penetrating injury)[4]
- Patch is not routinely recommended[5] and can prolong healing time[6]
Disposition
See Also
External Links
References
- ↑ [1], Ramirez DA. Ocular Injury in United States Emergency Departments: Seasonality and Annual Trends Estimated from a Nationally Representative Dataset. Am J Ophthalmol. 2018;191:149-155.
- ↑ Waldman N, et al. Topical tetracaine used for 24 hours is safe and rated highly effective by patients for the treatment of pain caused by corneal abrasions: a double-blind, randomized clinical trial. Acad Emerg Med. 2014; 21(4):374-82.
- ↑ Salim Rezaie, "Topical Anesthetic Use on Corneal Abrasions", REBEL EM blog, April 21, 2014. Available at: https://rebelem.com/topical-anesthetic-use-corneal-abrasions/.
- ↑ Mukherjee P, et al. Tetanus prophylaxis in superficial corneal abrasions. Emerg Med J. 2003; 20:62-64.
- ↑ Flynn CA, et al. Should we patch corneal abrasions? A meta-analysis. J Fam Pract. 1998; 47(4):264-70.
- ↑ Fraser, S. Corneal abrasion. Clin Ophthalmol. 2010; 4:387-390.