Diferencia entre revisiones de «Corneal laceration»
Sin resumen de edición
Línea 2: Línea 2:
==Background==
==Background==
[[File:Schematic diagram of the human eye en.png|thumb|Eye anatomy.]]
[[File:Schematic diagram of the human eye en.png|thumb|Eye anatomy.]]
*Common traumatic injuries to the eye, most often associated with penetrating injury or impact with debris.<ref>[https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6014923/], 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.</ref>   
*Traumatic injury to the eye, most often associated with penetrating injury or impact with debris.<ref>[https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6014923/], 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.</ref>   
*Must rule out full-thickness corneal laceration (i.e., [[globe rupture]]), which is a medical emergency   
*Must rule out full-thickness corneal laceration (i.e., [[globe rupture]]), which is a medical emergency   


Revisión del 20:05 29 may 2024

For full-thickness corneal lacerations see globe rupture

Background

Eye anatomy.
  • Traumatic injury to the eye, most often associated with penetrating injury or impact with debris.[1]
  • Must rule out full-thickness corneal laceration (i.e., globe rupture), which is a medical emergency

Clinical Features

  • Foreign body sensation
  • Photophobia (+/- consensual)
  • Decreased vision
    • If associated iritis or if abrasion occurs in visual axis
  • Eye pain
    • Relief of pain with topical anesthesia

Differential Diagnosis

Unilateral red eye

^Emergent diagnoses ^^Critical diagnoses

Evaluation

Workup

Diagnosis

Management

See globe rupture for full thickness lacerations.

Antibiotics

Does Not Wear Contact Lens

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
  • Ophthalmic NSAIDs
  • 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

Disposition

(Assuming no globe rupture)

  • Ophtho follow up in 48h for routine cases

See Also

External Links

References

  1. ↑ [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.
  2. ↑ 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.
  3. ↑ Salim Rezaie, "Topical Anesthetic Use on Corneal Abrasions", REBEL EM blog, April 21, 2014. Available at: https://rebelem.com/topical-anesthetic-use-corneal-abrasions/.
  4. ↑ Mukherjee P, et al. Tetanus prophylaxis in superficial corneal abrasions. Emerg Med J. 2003; 20:62-64.
  5. ↑ Flynn CA, et al. Should we patch corneal abrasions? A meta-analysis. J Fam Pract. 1998; 47(4):264-70.
  6. ↑ Fraser, S. Corneal abrasion. Clin Ophthalmol. 2010; 4:387-390.
Obtenido de «https://www.wikem.org/w/index.php?title=Corneal_laceration&oldid=373751»