Eye Conditions
AM is a 22-year-old man presenting to the local emergency department (ED) with acute onset
of right eye pain. The pain started 6 hours prior and has not improved with artificial tears or oral
acetaminophen. He reports the possibility of accidentally “scratching his right eye” when trying
to remove his contact lens.
Past Medical History
• Wears soft contact lenses, replaces monthly
• Denies swimming or showering in contacts
• Occasionally sleeps in contacts
Physical Examination
• Visual acuity: right eye, 20/40; left eye, 20/20
• Right eye is diffusely injected, small pinpoint area of haze is noted in the periphery at 6 o’clock; region subsequently stains with fluorescein
Discussion Questions
1. What is the appropriate pharmacologic treatment for AM?
2. What is the appropriate follow up for AM?
3. How should AM be counseled regarding his contact lens
3. Support all posts with at least 2 cited peer review references within 5 years of publication (references cannot be older than 5 years).
Sample Solution
The appropriate pharmacologic treatment for AM is a topical corticosteroid. These are used to reduce inflammation and may also reduce any pain or discomfort he is experiencing. In addition, antibiotics should be prescribed to prevent infection from the eye injury. A broad-spectrum antibiotic such as erythromycin or a topical fluoroquinolone such as ofloxacin can be used (American Academy of Ophthalmology [AAO], 2018). If there is no response to these medications after 24 hours, then a referral to an ophthalmologist should be considered as this could indicate more serious complications (AAO, 2018).
The appropriate follow up for AM will depend on the severity of his condition and the response to medication. If possible, it would be beneficial for him to follow up with an ophthalmologist within 24-48 hours in order to assess the extent of his injury and make sure that treatment is effective (AAO, 2018). It is important that he avoids further contact lens wear until given clearance by an ophthalmologist so as not to risk further damage or infection (AAO, 2018). Education about proper contact lens wear must also be provided in order for him to avoid similar situations in future; this includes ensuring that contacts are properly cleaned and disinfected each day prior to being worn again (AAO, 2018).
In summary , initial treatment should include prescription antibiotics and topical steroids while awaiting referral if needed . Follow-up with an optometrist/ophthalmologist should occur within 48 hours if no improvement noted . Proper contact lens hygiene instructions must be provided including avoidance of sleeping in contacts which can increase chance of infections ( AAO ,2018).
