Wednesday, January 23, 2008

Vol 2:4 Question





Eye Pain
A 24-year-old woman presents to the ED complaining of right eye pain and blurry vision since waking up this morning. She states that the pain began after taking out contact lens that were in her eyes for over one week. Her blood pressure is 120/75 mm Hg, heart rate is 75 beats per minute, temperature is 99.1°F, and respiratory rate is 16 breaths per minute. Her right and left eye visual acuity is 20/60 and 20/20, respectively. Her conjunctivae are injected. The slit lamp exam reveals a large area of fluorescein uptake over the visual axis. Which of the following is the most appropriate therapy?

a. Call the ophthalmology consult for an emergent corneal transplant

b. Prescribe a systemic analgesic for pain control and advise the patient to not wear her contact lenses for the next week

c. Prescribe ciprofloxacin eye drops, oral analgesia, update tetanus prophylaxis, and arrange for ophthalmology follow up

d. Prescribe oral amoxicillin, a topical anesthetic such as tetracaine and have patient follow up with an ophthalmologist

e. Prescribe ciprofloxacin eye drops and have patient strictly wear an eye patch until her pain resolves

Please submit your answer in the "comment" section. The person with the most correct entries at the end of six weeks will receive a copy of the book PreTest Emergency Medicine.

For more information about the contest, please click here.

quizzER is a weekly contest consisting of a question selected from various areas of emergency medicine that are central to the education of medical students and residents in training. For more information please refer to the following link.

9 comments:

NPG said...

C. Prescribe ciprofloxacin eye drops, oral analgesia, update tetanus prophylaxis, and arrange for ophthalmology follow up

AtYourCervix said...

B - it's a corneal scratch from long term wear of contact lenses. She really shouldn't wear them for so long, unless they were designed to be in that long. The eyes sometimes need just an overnight rest from contact lenses.

Also - to note - if she's not wearing her contact lenses, then how does she have such good visual acuity? Is she wearing glasses instead? (Coming from a die-hard contact lens wearer who doesn't even own a pair of glasses!)

The T-Dude said...

I would go with answer C.

Contact lens-associated corneal abrasions warrant antibiotic treatment to prevent ulcers. Coverage for gram-negative organisms (especially pseudomonads) is recommended so go with the Cipro. Since studies of patching for corneal abrasions have shown no benefit, that makes C my answer!

ArkieRN said...

c. Prescribe ciprofloxacin eye drops, oral analgesia, update tetanus prophylaxis, and arrange for ophthalmology follow up

tpsuhr said...

Corneal abrasion. My choice is "C".

prnpenguin said...

c. Prescribe ciprofloxacin eye drops, oral analgesia, update tetanus prophylaxis, and arrange for ophthalmology follow up

I would also imagine that she wouldn't be be able to wear a contact lens in her right eye for a while.

Rune said...

c. topical cipro, oral analgesia, opthal. f.u.

Rana said...

C

WongML said...

c. Prescribe ciprofloxacin eye drops, oral analgesia, update tetanus prophylaxis, and arrange for ophthalmology follow up