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 to determine the presence of a foreign body globe rupture orbital fracture retrobulbar hemorrhage or hematoma requires emergent lateral canthotomy to reduce intraoocular pressure Treatment tetanus prevention indication in patients with eyelid lacerations modalities tetanus immunoglobulin in patients who have never been immunized tetanus toxoid in patients who have not been immunized in the preceding 10 years in patients who have not been immunized in the preceding 5 years and have unclean or puncture wounds antibiotics indication in patients who have an eyelid laceration secondary to animal bites proper wound irrigation is needed notes patients may need rabies prophylaxis laceration repair indication in patients with an eyelid laceration 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 prevents the opening of the eye 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 used to address the risk of infection in patients with corneal abrasion medications erythromycin (ointment preferred) used in patients with corneal abrasion secondary to foreign body trauma recurrent abrasion fluoroquinolone or tobramycin used in patients with corneal abrasion secondary to contact lenses 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 it may not alter vision 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 to located the intraocular foreign body this is the imaging study of choice the intraocular foreign body or vitreous humor may be cultured when infection is suspected Treatment antibiotic therapy indication to address the risk of infection and may be started before surgery is initiated tetanus prophylaxis indication used depending on the patient's tetanus immunization status ophthalmic surgery indication definitive treatment to remove the foreign body 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