Snapshot A 27-year-old man presents to the emergency department after "feeling an object entering his eye" while hammering a metal nail into the wall. He reports mild discomfort in his right eye but denies any changes in his vision. On physical exam, no visual acuity deficit is appreciated. Slit-lamp examination with fluorescein staining demonstrates a small penetrating wound injury. A computerized tomography (CT) scan of the eye demonstrates a hyperdense lesion within the vitreous cavity. (Intraocular foreign body) Eyelid Laceration Definition a lesion affecting the eyelid Pathogenesis a blunt or penetrating injury affecting the eyelid (e.g., a child hitting their eyelid on a chair) Presentation physical exam laceration to the eyelid Studies management approach the mechanism of injury must be elucidated in order to determine if there are any other accompanying injuries (e.g., globe injury and the presence of an intraocular foreign body) computerized tomography (CT) scan of the eye indication login to view 6 more bullets Treatment tetanus prevention indication login to view 1 more bullet modalities login to view 5 more bullets antibiotics indication login to view 2 more bullets notes login to view 1 more bullet laceration repair indication login to view 1 more bullet Corneal Abrasion Definition damage to the corneal epithelium secondary to trauma Pathogenesis etiology trauma (physical or chemical) dry eye intraocular foreign body contact lenses Presentation symptoms severe eye pain photophobia may mention they have a foreign body sensation in the affected eye login to view 1 more bullet Studies management approach patients should have a complete eye examination and an open globe must be ruled out fluorescein staining and slit-lamp examination confirms the diagnosis culture very rarely performed most common pathogen is coagulase negative staphylococcus Treatment dependent on the cause e.g., if the corneal abrasion is caused by a foreign body, the foreign body is removed topical antibiotics indication login to view 1 more bullet medications login to view 8 more bullets Definition exposure to chemical irritant Pathogenesis acid hydrochloric acid in pool cleaners sulfuric acid in car batteries can denature proteins in the cornea alkali cleaning solutions (i.e., ammonia and lye) fertilizers direct surface damage can also penetrate cell membrane (lipophilic) causing injury to deeper structures in the globe of the eye Treatment initial management immediate irrigation with tap water or saline do not use acid or alkali solutions do not delay irrigation to contact a medical provider or to go to the ED further management depends on severity of injury as assessed by an ophthalmologist often includes a topical antibiotic to prevent superinfection may also include a topical steroid to decrease inflammation for severe injury, debridement of necrosis may be indicated Intraocular Foreign Body Definition a foreign body found within the eye Pathogenesis a foreign body traverses the eye (e.g., metal rods and shattered glass) most cases are a metallic foreign body and are found in the vitreous cavity Presentation symptoms patients may describe feeling an object entering the eye login to view 1 more bullet physical exam may find an entering wound Studies a slit-lamp examination with fluorescein stain is performed computerized tomography (CT) scan of the eye indication login to view 2 more bullets the intraocular foreign body or vitreous humor may be cultured when infection is suspected Treatment antibiotic therapy indication login to view 1 more bullet tetanus prophylaxis indication login to view 1 more bullet ophthalmic surgery indication login to view 1 more bullet Corneal Ulcer Definition an ulcer of the cornea commonly caused by bacteria Pathogenesis a bacterial infection from trauma or extended contact lens use Presentation symptoms profound eye pain and impaired vision physical exam a red eye without unique findings impaired vision Studies slit lamp exam with fluoresein stain uptake in the corneal ulcer with an oval, ragged border lesion Treatment topical antibiotics ciprofloxacin for contact lens wearers (covers for Pseudomona aeruginosa) surgical debridement emergently performed