3-25
Acute angle-closure glaucoma - age over 40; decrease in visual acuity; history of previous episodes of eye
pain
Scleritis or iritis - often associated with systemic inflammatory disorders
Conjunctivitis - acute onset; the presence of a discharge
Blepharitis - chronic recurrent eyelid inflammation; more common in older patients; usually bilateral, but one
eye may be worse
Ultraviolet keratitis - bilateral eye pain; sunburned face; maximum intensity several hours or longer after
exposure; fluorescein staining typically reveals numerous small dots of stain uptake called superficial punctate
keratitis or SPK.
Episcleritis - benign and self-limited inflammation of the episclera (the lining of the eye between the
conjunctiva and the sclera); identified by sectors of redness, no discharge and often a history of previous
episodes; discomfort is typically mild or absent.
Conjunctival foreign body - identification of the foreign material
Dry eye - usually bilateral and may result in secondary tearing; history of previous episodes; occurs in dry
environments.
Contact lens overwear syndrome - as in dry eye, except that the symptoms are magnified by the presence
of contact lenses
Subconjunctival hemorrhage - bleeding often seen with coughing or retching; innocuous and self-limited
Plan:
Treatment
Herpes simplex keratitis: Expedited evacuation; do not use steroids; patch eye.
Corneal erosion (abrasion and ulcer): See Eye Injury Section.
Angle-closure glaucoma (ACG): Acetazolamide 250 mg qid po; emergently evacuate since markedly
elevated intraocular pressures may result in permanent damage to the optic nerve in 24 hours or less.
Scleritis or iritis: Prednisolone 1%, 1 drop q1 hour continuously until evacuated. Patch eye; scopolamine
0.25%, 1 drop bid; expedite evacuation; if no improvement in 24-48 hours and not yet evacuated, start
prednisone 80 mg qd until evacuated.
Conjunctivitis: Ciprofloxacin ophthalmic drops 1 drop qid for 5 days.
Blepharitis: Bacitracin ophthalmic ointment applied to the lid margins q hs x 3-4 weeks; apply qid for 1
week in more severe cases; warm compresses for 10 minutes bid-qid. Follow by gently wiping away of the
inflammatory material on the eyelashes.
Ultraviolet Keratitis: Bacitracin ophthalmic ointment qid until signs and symptoms resolve; sunglasses;
patch severely affected eyes for comfort; scopolamine 0.25%, 1 drop bid or systemic analgesia may be
required for pain relief; monitor daily until epithelial staining resolves to ensure that they do not develop a
corneal ulcer.
Episcleritis: Usually resolves without treatment over several weeks; use prednisolone 1% drops qid x 3
days if persistent and patch eye.
Foreign body: (See Eye Injury section.)
Dry eye: Artificial tears prn to relieve symptoms; systemic rehydration; sunglasses or goggles for protection.
Overwear syndrome: Re-wet contact lens and use sunglasses; if ineffective, remove the contact lenses and
use glasses; if significant SPK are present on fluorescein staining, use ciprofloxacin or ofloxacin 1-2 drops
qid until the SPK have resolved; do not replace contact lenses until the eye is symptom-free.
Subconjunctival hemorrhage: Will resolve without treatment over one to two weeks.
Patient Education
General: Discuss the level of injury with the patient but do not give prognosis in diseases that should be
managed at a higher level of care.
Activity: As tolerated
Diet: As tolerated
Prevention and Hygiene: Keep eyes clean. Avoid spreading conjunctivitis to the other eye or other
individuals. Contact lens wearers in the wilderness should always carry a pair of glasses that can be worn
if contact lens problems arise.