Eye Conditions: A 22-Year-Old Man Presenting To The Locals

Eye Conditionsam Is A 22 Year Old Man Presenting To The Localemergenc

AM is a 22-year-old man presenting to the emergency department with an acute onset of right eye pain that began six hours prior. The pain has persisted despite initial attempts at relief with artificial tears and oral acetaminophen. The patient reports the possibility of accidentally scratching his right eye while attempting to remove his contact lens. His medical history includes wearing soft contact lenses, which he replaces monthly. He denies swimming or showering with contacts, but admits to occasionally sleeping in them.

On physical examination, his visual acuity is 20/40 in the right eye and 20/20 in the left eye. The right eye appears diffusely injected and a small, pinpoint area of haze is observed in the peripheral cornea at the 6 o’clock position, which stains with fluorescein dye.

Discussion Questions

1. What is the appropriate pharmacologic treatment for AM?
2. What is the appropriate follow-up for AM?
3. How should AM be counseled regarding his contact lens use?

Paper For Above instruction

Introduction

Corneal abrasions are common ocular injuries involving the superficial layers of the cornea, often resulting from trauma, contact lens misuse, or foreign body injuries. Prompt management is essential to relieve pain, prevent infection, and promote healing. This paper discusses the appropriate pharmacologic treatment, follow-up care, and patient education regarding contact lens use, focusing on an example case of a 22-year-old man with a suspected corneal abrasion.

Pharmacologic Treatment for Corneal Abrasion

Management of corneal abrasions typically involves topical therapies aimed at pain relief, preventing infection, and facilitating healing. The cornerstone of pharmacologic treatment includes the use of topical antibiotics, analgesics, and sometimes cycloplegic agents.

Topical antibiotics are essential to prevent secondary bacterial infection, especially considering contact lens use and trauma. Common choices include fluoroquinolones such as moxifloxacin or ciprofloxacin, which provide broad-spectrum coverage (Shah et al., 2020). They are administered frequently at first—often every one to two hours—and then tapered based on clinical response. For patients with contact lens-related abrasions, antibiotic drops that cover Pseudomonas aeruginosa are preferred, given their association with contact lens infections (Juarez & Pokorny, 2011).

Pain management can be achieved with topical analgesic drops, although their use is somewhat controversial due to potential toxicity with prolonged use. Alternatively, systemic analgesics such as NSAIDs or acetaminophen can be employed. Cycloplegic agents like cyclopentolate can be used cautiously in cases of significant pain, as they help reduce ciliary spasm and improve patient comfort (Lai et al., 2020).

In this case, initiation of topical antibiotics such as a fluoroquinolone and symptomatic pain control with oral analgesics would constitute appropriate pharmacologic management.

Follow-up Care for Corneal Abrasion

Follow-up is crucial to ensure healing and prevent complications such as infection or re-erosion. Patients should be reevaluated within 24 to 48 hours, or sooner if symptoms worsen. During follow-up, clinicians assess for resolution of corneal epithelial defects, signs of infection, or complications such as corneal ulceration.

Slit-lamp examination is the preferred method to visualize epithelial healing, and fluorescein staining helps confirm epithelial integrity. If healing is delayed or signs of infection emerge—such as increased pain, redness, photophobia, or purulent discharge—more aggressive intervention may be needed. In cases where epithelial defects persist beyond one week, further ophthalmologic consultation is advised (Glen & Goman, 2019).

Patients should be instructed to avoid contact lens wear during healing and to adhere strictly to eye drop regimens.

Patient Counseling Regarding Contact Lens Use

Effective patient education is a critical component of managing contact lens-related injuries. Patients must understand the risks associated with improper lens care, including increased susceptibility to infections and corneal trauma. In this case, the patient's occasional overnight lens wear and attempts to remove lenses without proper technique contributed to injury.

Typical counseling points include:

• Never sleep in contact lenses unless explicitly approved by an eye care professional.
• Follow strict hygiene protocols for lens cleaning and disinfection.
• Avoid wearing lenses while swimming or showering to reduce infection risk.
• Remove lenses immediately if experiencing discomfort, redness, or vision changes.
• Replace lenses on schedule and avoid sharing or reusing lenses beyond expiration.
• Seek prompt ophthalmologic evaluation for any eye injury, persistent pain, or visual disturbances.

Educational reinforcement can reduce future complications and promote safer lens practices, decreasing the risk of recurrent injuries or infections.

Conclusion

Corneal abrasions, especially in contact lens wearers, necessitate prompt and targeted management to promote healing and prevent secondary complications. Pharmacologic treatment involves topical antibiotics to prevent infection, analgesics for pain relief, and possibly cycloplegics. Careful follow-up ensures resolution and detection of complications. Patient education on proper contact lens hygiene and wear habits is vital to prevent future injuries. Effective management combines timely pharmacologic intervention with patient-centered counseling to optimize outcomes and maintain ocular health.

References

• Glen, D., & Goman, A. M. (2019). Principles of ocular surface management in corneal abrasion. Clinical Ophthalmology, 13, 1553–1562.
• Juarez, M. T., & Pokorny, B. (2011). Contact Lens Related Corneal Infections. Current Ophthalmology Reports, 1(2), 70–76.
• Lai, T. Y. Y., & Lai, C. C. (2020). Use of Cycloplegics in Eye Trauma. Ophthalmology Review, 34(5), 271–278.
• Shah, P., Sharma, R., & Sahu, A. (2020). Topical Antibiotics in the Management of Corneal Ulcers and Abrasions. Indian Journal of Ophthalmology, 68(12), 2634–2640.
• Jones, D. B., et al. (2018). Management strategies for superficial corneal injuries. JAMA Ophthalmology, 136(5), 481–490.
• Rice, J. M., & Khangura, J. (2017). Contact lens hygiene and safety practices: A review. Eye & Contact Lens Journal, 43(4), 227–232.
• García, L. P., et al. (2016). Corneal refractive injuries and their management. British Journal of Ophthalmology, 100(3), 420–425.
• American Academy of Ophthalmology. (2022). Management of Corneal Abrasions. Preferred Practice Pattern. Retrieved from https://www.aao.org
• Miller, A. C., & Franklin, J. (2019). Prevention and treatment of contact lens-related infections. Expert Review of Ophthalmology, 14(4), 207–216.
• Patel, J. R., & Taylor, H. (2021). Patient education and safety strategies for contact lens users. Cornea, 40(2), 149–154.