Corneal abrasion

Symptoms: Pain FB sensation Photophobia Tearing

Signs Epithelial defect with fluorescein staining Conjunctival injection Possible foreign body

Management Pressure patch with antibiotic ung Bandage contact lens with topical antibiotic and NSAID Topical NSAID and
antibiotic Refer to eye care provider to rule-out ruptured globe
Foreign body
Symptoms: FBS Tearing Blurred vision Photophobia History of FB or rust ring

Signs Conjunctival injection Eyelid edema Small infiltrate surround FB

Recurrent corneal erosion

SignsRecurrent abrasions secondary to prior history of trauma or corneal dystrophy Due to poor adhesion between epithelium and
bowmans layer
Corneal dystrophies-Many different types
Often autosomal dominant No associated systemic or ocular disease Central corneal involvement May need penetrating
keratoplasty
Treatment Acute- same as regular abrasion Chronic- add hypertonic ung and gtts Muro 128 sol and ung Extended wear CL
Anterior stromal micropuncture Phototherapeutic keratectomy (PTK)
Keratitis-Inflammation or infection of cornea
bacterial-Epithelial defect with underlying stromal infiltrate A.K.A. Corneal ulcer

Symptoms Pain Photophobia Blurred vision Mucous discharge

Signs Focal white opacity in stroma (infiltrate) Fluorescein staining Deep injection Anterior chamber cells and flare (uveitis)

Management Topical antibiotics Can culture ulcer

Viral-EKC Epidemic keratoconjunctivitis

symptoms: Tearing, lid swelling, photophobia

Signs: Pinkish injection Corneal infiltrates Lid edema Profuse tearing Blurred visual acuity

Management Artificial tears Topical steroid

fungal-May result after trauma with vegetative matter Immunosuppressed patients

Management-Topical antifungal (natamycin)

HZV Herpes zoster varicella virus

Symptoms Pain Headache Fever Malaise injection

Signs Characteristic skin lesions along forehead Acute vesicular rash that follows CN V dermatome
Ocular signs Corneal pseudodendrites Superficial punctate keratitis (SPK) Uveitis Scleritis Glaucoma

Management Oral antivirals Antibiotic ung to skin lesions Amitryptyline 25 mg TID for post-herpetic neuralgia Warm compresses
PRN Refer to eye care provider to monitor other pathology
Herpes Simplex Virus Most common human virus affecting skin and mucous membranes
Initial HSV-1 infection occurs 1-5 years of age Dormant virus lies in trigeminal ganglion Reactivated by trigger mechanism

Symptoms Unilateral red eye Pain Photophobia Tearing Blurred vision Clear skin lesions along lids Possible prior occurrences

Signs SPK Dendrites Ulcer Decreased corneal sensitivity

Work-up Q-tip test Rule-out FB or corneal abrasion Health history

Management Warm compresses to lids Conjunctivitis- Topical anti-viral Viroptic 5X qd Keratitis- Viroptic 9X qd Consider longterm
acylovir if recurrent
Hyphema Blood in anterior chamber

Traumatic

Spontaneous -Refer to eye care provider for treatment Often Diabetic neovascularization of the iris May need systemic
work-up to rule-out bloodclotting disorder
Symptoms Blurred vision History of trauma
Work-up Check visual acuity Rule-out ruptured globe Refer to eye care provider
Management Bed rest with head elevation Dilate pupil (cyclogel or atropine) Topical steroid (prednisolone) if significant
inflammation exists May need surgical wash-out Monitor for reoccurrence
Uveitis Inflammation of uvea (iris, cililary body, choroid)
Anterior Uveitis Inflammation of Iris and Ciliary Body

Etiology: Idiopathic (50%) Trauma Underlying systemic disease

Symptoms Pain Photophobia Tearing Blurred vision Usually no history of trauma


Signs Injection Miosis No discharge Posterior synechiae Anterior chamber cells and flare Cataract Glaucoma

Management Refer to eye care provider Dilate pupil Topical steroid 1gtt q1-2 hrs Determine etiology May need oral
prednisone 40-80 mg May need intraocular injection of methylprednisone
Posterior uveitis Inflammation of choroid

Etiology Toxoplasmosis Toxocariasis Sarcoidosis Syphillis CMV Ocular histoplasmosis TB

Symptoms Blurred vision Floaters

Signs: Vitreous cells Retinal/choroidal infiltrate, edema Glaucoma, cataract, vasculitis

Management Full physical and systemic meds Intraocular injections of steroids

Arcus senilis
Etiology Asymptomatic, bilateral white mid-peripheral lipid ring Often familial <50 years of age need physical and blood work-up to
rule-out cardiovascular disease
Pterygium
Etiology Slow-growing lesion on nasal corneal surface Usually bilateral Stimulated by UV exposure or mechanical irritation Can be
asymptomatic
Management Artificial tears PRN Topical steroid or NSAID PRN Surgical excision may be necessary

Refractive surgery Myopia- near sighted (cornea is too steep or axial length is long) Hyperopia- far sighted (cornea is too flat or axial
length is short) Presbyopia natural loss of accommodation due to inability of ciliary body to bend lens
Intraocular contact lens

Inserted posterior to iris Anterior to crystalline lens Good for high refractive errors

PRK-Photorefractive keratectomy

Excimer laser ablates and reshapes cornea

LASIK

Laser-assisted keratomellieius Correct refractive error by cutting a flap, reshape cornea stromal bed, and replacing the fla