Review Question - QID 214568

This patient is presenting with severe eye pain after working at a construction site with erythema of the right eye and pain with blinking. Given the fluorescein stain demonstrating uptake in a linear fashion, this is likely a corneal abrasion.

A corneal abrasion occurs when a foreign body injures the cornea. Patients will often complain of severe eye pain worse with blinking, blurry vision, and photophobia. Patients should first have their eyelid everted to search for and remove any retained foreign body. Irrigation may aid in this effort. Next, a fluorescein stain should be performed to assess for injury to the cornea. The treatment of a corneal abrasion is topical erythromycin ointment. In contact lens wearers, there is increased risk of Pseudomonas aeruginosa infection; thus, topical therapy must cover for this organism (including drugs such as topical ciprofloxacin).

Figure/Illustration A demonstrates a fluorescein stain with linear uptake (red arrows) which is concerning for a corneal abrasion.

Incorrect Answers:
Answer 1: Acute closed angle glaucoma presents with a rock hard and painful eye. Dilation of the pupil obstructs outflow of aqueous humor causing sudden, severe eye pain and a hazy pupil. The diagnosis can be confirmed with tonometry, and treatment can involve pilocarpine drops, timolol drops, acetazolamide, and iridotomy.

Answer 3: Corneal ulcer presents with severe, exquisite eye pain and is common in contact lens wearers who forget to remove their contacts. Management requires debridement, topical antibiotics, and possibly topical anti-fungal agents.

Answer 4: Herpes simplex virus keratitis presents with blurred vision, eye pain, erythema, and dendritic ulcers in the eye on fluorescein stain. Treatment involves topical trifluoridine and acyclovir.

Answer 5: Open globe presents after blunt or penetrating trauma to the eye with eye pain and a positive Seidel sign (leakage of fluid from the eye on fluorescein stain). Management involves keeping the head elevated, avoidance of tonometry/applying pressure to the eye, and ophthalmologic surgical repair.

Bullet Summary:
A corneal abrasion presents after trauma to the eye with severe eye pain, photophobia, pain with blinking, and fluorescein uptake in the area of trauma.