Posted: January 18th, 2023

AM is a 22-year-old man presenting to the local emergency department (ED) with acute onset

Week 2 Discussion

Eye Conditions

AM is a 22-year-old man presenting to the local emergency department (ED) with acute onset

of right eye pain. The pain started 6 hours prior and has not improved with artificial tears or oral

acetaminophen. He reports the possibility of accidentally “scratching his right eye” when trying

to remove his contact lens.

Past Medical History

• Wears soft contact lenses, replaces monthly

• Denies swimming or showering in contacts

• Occasionally sleeps in contacts

Physical Examination

• Visual acuity: right eye, 20/40; left eye, 20/20

• Right eye is diffusely injected, small pinpoint area of haze is noted in the periphery at 6 o’clock; region subsequently stains with fluorescein

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

1 PAGE TO ANSWER THE 3 QUESTIONS

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The appropriate pharmacologic treatment for AM would likely include an antibiotic to treat any potential infection, as well as a topical corticosteroid to reduce inflammation and pain. The specific antibiotic used may depend on the results of any laboratory testing, such as a culture of the eye, but commonly used options include drops or ointments containing neomycin, polymyxin, and bacitracin (also called a triple antibiotic ointment) or topical antibiotics such as fluoroquinolones like Ciprofloxacin, Levofloxacin or ofloxacin. Topical corticosteroids such as prednisolone or dexamethasone may also be prescribed.

The appropriate follow up for AM would include close monitoring of his eye for any signs of improvement or deterioration, and an assessment of the response to treatment. Depending on the severity of the condition, follow-up visits with an ophthalmologist may be recommended to ensure proper healing and to assess for any potential complications. The patient should also be instructed to return to the ED or seek immediate attention from an ophthalmologist if the pain or vision worsens, if there is significant worsening of redness, or if there are any new symptoms that arise.

AM should be counseled on the proper use and care of his contact lenses to prevent a recurrence of the problem. This could include:
-Advising against wearing the contact lens when experiencing any discomfort or pain,
-Reiterating the importance of washing hands before handling the contact lenses,
-Proper cleaning, disinfection and storage of the contact lens,
-Instructions on when to replace contact lens,
-Advising against sleeping in contact lens unless specifically cleared by the ophthalmologist
-Advising against showering or swimming in contact lens as well.

It is also important to educate him about the symptoms of an infected or inflamed eye and warn him that if he experiences similar symptoms again, it is best to seek medical attention and remove the contact lens as soon as possible.