injuries poisoning
Corneal Abrasions and Foreign Bodies
Treatment
For surface foreign bodies, irrigation or removal with a damp, cotton-tipped swab or a small needle For corneal abrasions, antibiotic ointment and sometimes pupillary dilation For intraocular foreign bodies, surgical removal After an anesthetic is instilled into the conjunctiva, clinicians can remove conjunctival foreign bodies by irrigation or lift them out with a moist sterile cotton applicator. A corneal foreign body that cannot be dislodged by irrigation may be lifted out carefully on the point of a sterile spud (an instrument designed to remove ocular foreign bodies) or of a 25- or 27-gauge hypodermic needle under loupe or, preferably, slit-lamp magnification; the patient must be able to stare without moving the eye during removal. Steel or iron foreign bodies remaining on the cornea for more than a few hours may leave a rust ring on the cornea that also requires removal under slit-lamp magnification by scraping or using a low-speed rotary burr; removal is usually done by an ophthalmologist. Residual corneal abrasions are treated. An ophthalmic antibiotic ointment (eg,bacitracin/polymyxin Borerythromycin) is used for most abrasions until the epithelial defect is healed. Contact lens wearers with corneal abrasions require an antibiotic with optimal antipseudomonal coverage (eg,ciprofloxacin0.3% ointment 4 times a day). For symptomatic relief of larger abrasions (eg, area>10 mm2), the pupil is also dilated once with a short-acting cycloplegic (eg, one dropcyclopentolate1% or homatropine 5%). Eye patches may increase risk of infection and are usually not used, particularly for an abrasion caused by a contact lens or an object that may be contaminated with soil or vegetation. Ophthalmic corticosteroids tend to promote the growth of fungi and reactivation of herpes simplex virus and are contraindicated. Continued use of topical anesthetics can potentially impair healing and is thus contraindicated. Pain can be managed with oral analgesics. Topical anesthetics should not be used. Topical NSAID drops are not approved for this treatment, if used in select patients closer follow-up should be arranged. The corneal epithelium regenerates rapidly; even large abrasions heal within 1 to 3 days. A contact lens should not be worn until the injury is healed. Follow-up examination by an ophthalmologist 1 or 2 days after injury is wise, especially if a foreign body was removed. Intraocular foreign bodies require immediate surgical removal by an ophthalmologist. Systemic and topical antimicrobials (effective againstBacillus cereusif the injury involved contamination with soil or vegetation) are indicated; they includeceftazidime1 g IV every 12 hours, in combination withvancomycin15 mg/kg IV every 12 hours andmoxifloxacin0.5% ophthalmic solution every 1 to 2 hours. Ointment should be avoided if the globe is lacerated. A protective shield (eg, plastic or aluminum eye shield or the bottom third of a paper cup) is placed and taped over the eye to avoid inadvertent pressure that could extrude ocular contents through the penetration site. Patches should be avoided. Tetanus prophylaxis is indicated after open globe injuries. As with any laceration of the globe, vomiting (eg, due to pain), which can increase intraocular pressure, should be prevented. If nausea occurs, an antiemetic is given. 