Eye Pain and Visual Change Answers 501surgical therapy. Some ophthalmologists will follow patients with hyphemas
less than one-third of the anterior chamber as outpatients. However, oph-
thalmology should be urgently consulted while the patient is in the ED and
individual decisions can be discussed (a).
452.The answer is d.(Tintinalli, pp 1458-1459.)Chemical injuriesto
the eye must be irrigatedwith a minimum of 1 to 2 L of normal saline as
soon as they arrive in the ED. Topical anesthesia and the use of a Morgan
Lens (a special device to provide large volume irrigation to the eye) can
help facilitate this procedure.
(b)Irreversible eye damage can occur if irrigation is withheld for a physi-
cal examination and visual acuity testing. Checking the pH of the tears (c)
helps determine the effectiveness of irrigation, but should be checked after
irrigation has begun. When the ocular pH returns to 7.5 to 8.0, irrigation can
be stopped and a complete eye examination should be performed. Remember
to check visual acuity and pay special attention to corneal clouding or corneal
epithelial defects. (e)Patients with epithelial defects or corneal clouding should
receive an ophthalmic antibiotic. Patients without corneal or anterior cham-
ber involvement only need erythromycin ointment. The ophthalmologist
(a)should be notified, after initial stabilization, of all patients with chemi-cal
injury to the eye and follow-up should be arranged within 12 to 24 hours in
consultation with the ophthalmologist.
453.The answer is e.(Tintinalli, p 1459.)Fortunately, super glue or crazy
glue (cyanoacrylate) exposure to the eye is usually not permanently dam-
aging to the eye. Corneal irritation can occur from the hard, irregularly
shaped glue. To prevent this abrasive effect, large amounts of erythromycin
ointment should be applied to the eye and eyelids as a lubricant. Large
clumps of glue can be removed manually.
Instrumentation to remove all glue products (d)is not necessary in the
ED. The glue will loosen over time and be easier to remove in several days.
Washing the eye with normal saline (c)will not be helpful unless there are
large free clumps that will be washed away. (b)While applying acetone
may help remove cyanoacrylate from clothing and surfaces, acetone (or any
other chemical) should never be infused into the eye. (a)These patients
should follow-up with ophthalmology in 1 to 2 days.
454.The answer is a.(Tintinalli, p 1459.)These girls forgot to wear eye
protection while using the sun-tanning lights and have ultraviolet keratitis.