Eye Pain and Visual
Change
Answers
444.The answer is c.(Rosen, pp 752-754.)The patient most likely sus-
tained a corneal abrasionfrom prolonged contact lensuse. Epithelial
defects of the cornea are diagnosed by slit-lamp examination by observing
fluorescein uptakein the area of the defect. Treatment usually consists of
cycloplegia and topical or oral pain medications. Contact lens patients should
be treated with topical antibiotics with antipseudomonalcoverage. Patients
should not wear their contact lens until complete healing of the corneal
epithelium. All patients should follow-up with an ophthalmologist.
(a)Corneal abrasions usually heal well with appropriate care and do not
require a transplant. (b)A topical antibiotic should also be prescribed to pre-
vent secondary infection. (d)Amoxicillin is not an appropriate antibiotic
because it is not topical and not antipseudomonal. In addition, tetracaine, if
used frequently, can decompose the cornea and cause permanent damage.
(e)Eye patching should be avoided, particularly with injuries involving con-
tact lens. Data suggest that eye patching confers no benefit in healing small,
uncomplicated corneal abrasions and may provide a better environment for
pseudomonas to proliferate.
445.The answer is b.(Rosen, pp 1656-1657.)The patient has herpes
zoster,orshingles,an infection caused by the varicella-zoster virus.The
patient’s rash most likely involves the ophthalmic divisionof the trigeminal
nerve.In addition, the vesicles found on the tip of the patient’s nose corre-
late strongly with viral involvement of the eye. Hutchinson signis used to
denote vesicles on the tip of a patient’s nose in the setting of herpes zoster.
When there is ocular involvement the infection is called herpes zoster oph-
thalmicus. Ocular complicationsoccur in 20% to 70% of the cases involv-
ing the ophthalmic division of the trigeminal nerve. Severity varies from mild
conjunctivitis to panophthalmitis. In addition, the patient is at risk for ante-
rior uveitis, secondary glaucoma, and corneal scarring.
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