Pages

Wednesday, November 23, 2016

Corneal Foreign Body and Corneal Abrasion

 A 28-year-old man felt something fly into his eye while he was using a table saw without wearing protective eye gear. He presented with pain, tearing, photophobia, and thought that something was still in his eye.
On examination with a slit lamp, the physician noted that he had a wood chip that had penetrated the cornea (See pictures below)

                                Wood chip is visible in the cornea on close inspection of the eye.
\
                          Slit-lamp examination reveals this wood chip has penetrated the cornea.

He was referred to an ophthalmologist who successfully removed the foreign body. He was treated with a short course of topical NSAIDs for pain relief, and had complete healing.

Case Discussion:

Corneal Foreign Body and Corneal Abrasion

Introduction: Corneal abrasions are often caused by eye trauma and can cause an inflammatory response. Corneal abrasions are detected using fluorescein and a UV light. A corneal foreign body can be seen during a careful physical examination with a good light source or slit lamp.
Nonpenetrating foreign bodies can be removed by an experienced physician in the office using topical anesthesia. Refer all penetrating foreign bodies to an ophthalmologist.

Pathophysiology: The cornea overlies the iris and provides barrier protection, filters UV light, and refracts light onto the retina.
• Abrasions in the cornea are typically caused by direct injury from a foreign body, resulting in an inflammatory reaction.
• The inflammatory reaction causes the symptoms and can persist for several days after the foreign object is out.

History and Physical Examination:
• History of ocular trauma or eye rubbing (although corneal abrasions can occur with no trauma history).

• Symptoms of pain, eye redness, photophobia, and a foreign-body sensation.
• Foreign body seen with direct visualization or a slit lamp
• Fluorescein application demonstrates green area (which represents the disruption in the corneal epithelium) under cobalt-blue filtered light
• History of contact lens wear.
• History of ocular or perioral herpes virus infection.

Differential Diagnosis: 
Uveitis or iritis—Usually unilateral 360-degree perilimbal injection, eye pain, photophobia, and vision loss.
Keratitis or corneal ulcerations—Diffuse erythema with ciliary injection often with miosis; eye discharge; pain, photophobia, and vision loss depending on the location of ulceration  There is often a history of trauma, herpes simplex virus (HSV), or contact lens wear. Patients should see an ophthalmologist urgently.
Conjunctivitis—Conjunctival injection; eye discharge; gritty or uncomfortable feeling; no vision loss, history of respiratory infection, or contacts with others who have red eyes
Acute-angle closure glaucoma—Cloudy cornea and scleral injection; eye pain with ipsilateral headache; severe vision loss, acutely elevated intraocular pressure.

Management: 
• Confirm diagnosis with fluorescein and a UV light (for abrasion) if no foreign body is readily visible.
• Carefully inspect for a foreign body. Invert the upper eyelid for full visualization. Slit-lamp visualization may be needed to determine if the cornea has been penetrated.
• Remove (or refer for removal) non penetrating foreign bodies. Apply a topical anesthetic, such as proparacaine or tetracaine. Remove with irrigation, a wet-tipped cotton applicator, or a finegauge needle.
• Remove contact lenses until cornea is healed
• Avoid patching in corneal abrasions smaller than 10 mm; it does not help.
• Prescribe ophthalmic NSAIDs for pain if needed
• Consider topical antibiotics. Chloramphenicol ointment reduced the risk of recurrent ulcer in a prospective, nonplacebo, controlled trial. Although chloramphenicol is rarely used in the United States, other ophthalmic antibiotics, such as erythromycin ointment, are used for corneal abrasions.

1 comment:


  1. I feel so excited today because it's just a year since I got my breakthrough from Herpes.I was diagnosed of HSV1 on the 12/4/2015 and latter i got affected with the HSV2. That was my 2nd outbreak after i lost my ex fiance that got me affected with the virus. I was so scared when he died and what i heard about the Herpes virus as he's deathly and such has no cure. I feel so pity and and a disgrace to my personality,in my career and my family to have been in with the deathly sickness, and that would makes my love ones siblings stay far from me. I was going to my regular church activities when i begin to hear testimonies of how people get cure online, i never gave it a thought till my cousin Stephanie who was affected with HIV told me, Lenny you need not to worry cos i met i man today online , i traditional herbal healer whom two of her friends confirmed he cure them with his herbal herbs that i should give it a try. I saw the interest in her and she did contact the herbal doctor again in my present, luckily for me he picked and show up himself, behold he was at about to attain to some patients that have came back with appreciation of how he cure them from Cancer, HIV, and off much too the herpes he cured an 18 years old daughter.
    I was so happy that day, i wanted to be there but the distance was a barrier to me. I told him how the virus had eaten me up and and a truly believe there's cure for herpes. He told me me with assurance that my case wont be different and he had been curing lots of people With his herbal medicine and most people due contact him from the States and preperd the medicine and made use of the DHL to reach him.
    Honestly speaking Dr. Akpu power his a great and gifted herbalist,His destined to herbs.
    He made me do away with the medical prescription,the acyclovir (Zovirax), famciclovir(Famvir), and valacyclovir (valtrex). you don't know him because you haven't meet this man try and contact him yourself Dr. Akpu in Africa is popularly known in his City,and you can request for his address yourself. I'm so happy now cos,I and my cousin had been confirmed negative till date..the Lord is good in my life. Dr. Akpu sent me his herbal medicine that heal me too, 🙏 🙏 Dr. Akpu for giving me another life.
    Contact Dr.akpu for all kids of sickness@
    Dr.akpupowerherbscenter@gmail.com

    ReplyDelete