![]() ![]() Topical anesthetics should never be prescribed. Oral analgesics can be prescribed as needed for 1 day. An eye patch should never be applied if there is recent history of contact lens wear, potential vegetable matter, or a potential infection. Tape is applied diagonally across the forehead to the patient's cheekbone to tightly secure the pad and prevent blinking. A folded eye pad is placed over the closed lid and covered with a second eye pad. In addition, pressure patching for 24 hours may decrease pain and aid in healing. Large abrasions are treated with antibiotic ointments as noted in section E. Patients are seen within 1–2 days to ensure complete resolution of the abrasion without complication. Antibiotic ointments with steroids are contraindicated. Small abrasions are treated with ophthalmic ointment tid–qid, such as erythromycin, polymyxin/bacitracin, or bacitracin ointment. ![]() The upper lid also should be everted if the patient reports a history of a foreign body in the eye. After everting the upper lid to remove the foreign body, the abrasion is treated as indicated for small abrasions (see section E). Multiple linear streaks of fluorescein staining indicate a foreign body embedded in the upper lid until proved otherwise. An ophthalmology referral should be pursued if the patient is still symptomatic. Patients should use aggressive lubrication with artificial tears QID and erythromycin or another bland ointment QHS for 1 month. The examination is often normal because the abrasion has often healed by the time the patient is seen. Patients with recurrent erosion syndrome report a history of recurrent episodes of awakening with symptoms of a corneal abrasion. Fluorescein staining and examination under cobalt blue light will outline the area of denuded epithelium as a yellowish-green stain. On penlight examination, a corneal abrasion may show a normal corneal light reflection or an isolated irregular corneal light reflection in the area of the abrasion. If the abrasion is associated with a significant mechanism of injury (e.g., high-velocity foreign body), contact with vegetable matter such as a bush or tree, or associated contact lens wear, the patient should be referred to an ophthalmologist for examination because these situations have potential for more serious injury or more virulent or atypical pathogens. Topical anesthetics should never be prescribed for pain control because chronic use is toxic to the corneal epithelium. The most important management issues are to exclude more severe injury and to allow healing without infection. Corneal abrasions typically heal rapidly (within 1–2 days) depending on the extent of injury and the patient's age and health. ![]()
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