449.A 24-year-old girl presents to the ED at 4 AMwith severe left eye pain
that woke her from sleep. She wears soft contact lenses and does not rou-
tinely take them out to sleep. She is in severe pain and wearing sunglasses in
the examination room. You give her a drop of proparacaine to treat her pain
prior to your examination. On examination, her vision is at baseline and she
has no afferent pupillary defect. There is some perilimbic conjunctival ery-
thema. On fluorescein examination, a linear area on the left side of the cornea
is highlighted when cobalt blue light is applied. No underlying white infil-
trate is visualized. No white cells or flare are visualized in the anterior cham-
ber. What is the most appropriate treatment for this condition?
a. Immediate ophthalmology consult
b. Tobramycin ophthalmic ointment
c. Erythromycin ophthalmic ointment
d. Eye patch
e. Proparacaine ophthalmic drops
450.A 45-year-old woman presents with right eye pain and redness for 1 day.
She has photophobia and watery discharge from the eye. She does not wear
glasses or contact lenses and has no prior eye problems. On examination, the
patient’s visual acuity is 20/20 in the left eye and 20/70 in the right eye. She has
conjunctival injection around the cornea and clear watery discharge. On slit-
lamp examination, the lids, lashes, and anterior chamber are normal. When
fluorescein is applied, a branching, white-colored epithelial defect is seen. The
remainder of the head examination is normal and the patient has no cutaneous
lesions. Which of the following is the most appropriate treatment for this
patient?
a. Admission for intravenous (IV) antibiotics
b. Admission for IV antiviral agents
c. Topical steroids
d. Topical antiviral medication
e. Immediate ophthalmology consultation
492 Emergency Medicine