A5-year-old child was hit in the right eye by a toy. He is rubbing at his eye, which is watering profusely. There is a small abrasion at the corner of the eye. He is mildly photophobic, but his pupils are equal, symmetric, and reactive to light and accommodation. His vision is normal.
Which of the following is the most appropriate next step in the management of this patient?
- Perform a fluorescein dye stain of the cornea to determine if there is a corneal abrasion.
- Refer him immediately to an ophthalmologist.
- Irrigate the eye with sterile normal saline.
- Discharge him to home with antibiotic eye ointment.
- Apply a patch to the eye and follow-up in a week.
Answer(s): A
Explanation:
Superficial corneal injuries expose underlying layers causing pain, photophobia, tearing, and decreased vision. Irrigation is recommended only if a foreign body is suspected. Abrasions are detected by instilling fluorescein dye and inspecting the cornea using blue-filtered light. Treatment consists of frequent applications of topical antibiotic ointment until the epithelium is healed. The use of a patch does not accelerate healing, and if improperly applied, may abrade the cornea. Referral to an ophthalmologist should be considered if there are significant changes in vision, or signs of deeper or more penetrating injury which often result in papillary bnormalities.