CORNEA
1. | A 24-year-old contact lens wearer comes in with a two-day history of eye pain. |
Figure 1.1
Q | 1.1 What else do you want to know about in the history? |
â˘Blurring of vision
â˘Contact lens history
â˘Contact with soil or contaminated water
â˘Immunosuppression: diabetes, human immunodeficiency virus, steroids, chemotherapy onset
â˘Progression
â˘Previous treatment
â˘Pain
â˘Trauma
Q | 1.2 What are the signs? |
â˘Conjunctiva: injected
â˘Corneal ulcer/infiltrate involving the visual axis
â˘Central epithelial defect
â˘Hypopyon
Q | 1.3 What are your differential diagnoses? |
â˘Contact lens-related infective keratitis
â˘Exposure infective keratitis/neurotrophic infective keratitis
Q | 1.4 How do you manage the above patient? |
â˘Admit the patient
â˘Perform a corneal scrape and send for microscopy and cultures
â˘Intensive topical antibiotic treatment: gentamicin 14 mg/ml hourly, cephazolin 50 mg/ml hourly through the night
â˘Systemic antibiotic treatment if the infiltrate is near the limbus (oral ciprofloxacin 500 mg twice a day for a week)
Q | 1.5 What do you send the corneal scrapings for? |
â˘Gram stain
â˘Blood agar
â˘Chocolate agar
â˘Thioglycate
â˘Brain heart infusion broth (BHIB)
â˘Sabouraud dextrose
â˘Others
âŹSuspicious for fungal infection: giemsa stain, methenamine silver stain
Q | 1.6 What are the complications of a corneal ulcer? |
â˘Acute: thinning of the cornea resulting in corneal perforation leading to endophthalmitis
â˘Long-term: scar, astigmatism, blindness