A 25 year old male basketball player presents with R eye pain after being elbowed in the eye one hour prior to arrival. The eye is tearing and very painful, although his vision is preserved, and he feels that something may be stuck in the eye.
Exam of the eye shows PERRL, EOMI, 20/20 visual acuity in both eyes, injected conjunctiva. No foreign bodies are revealed on exam with everted lids. Fluorescein exam of the eye shows a 3 mm superficial corneal abrasion laterally.
How can you best help this patient?
Prescribe NSAIDs and antibiotics.
NSAID drops? Yes. These have been shown to be effective for pain relief with no significant increase in complications.
Antibiotic drops? Yes. Evidence is significantly weaker, but a few studies have shown a decreased rate of corneal ulceration with antibiotics compared to without, so it is reasonable to provide them. Ointment is preferred over eye drops as it provides better lubrication for the eye, although it is significantly messier and may be tolerated less well by patients – consult with your patient as to which they would actually use.
Patch the eye? No. This used to be common practice as the thought was that this would decrease blinking and therefore additional trauma from the eyelid, but it actually appears to impede wound healing by depriving it of oxygen, and increasing pain and probability of infection.
Mydriatics? No. These were formerly prescribe to treat pain from ciliary muscle spasm but have not been shown to be effective in improving patients reported pain.
Topical anesthetics? No. These decrease the rate of healing and can cause damage to the cornea.
Followup? 24 hours to ensure eye is healing appropriately. No contact lenses until eye is healed.