- Bacterial Conjunctivitis
- Corneal Foreign Body
- Globe Rupture
- Orbital Cellulitis
- Infection and inflammation of conjunctiva caused by bacteria (typically S. aureus). May be unilateral or affect both eyes. Commonly known as “pink eye”
- Pseudomonas aeruginosa most common cause for contact lens wearers
- Itchy eyes w/ discharge or crusting; usually worse in the morning; may say eyes are “glued shut” when waking up.
- Exam will show red/pink eye with yellow, purulent discharge
- Clinical diagnosis
- Antibiotic eye drops (ex. gentamicin/tobramycin) or ointment (ex. erythromycin)
- For contact lens wearers, use fluoroquinolone drops (ciprofloxacin)
*Deep Dive: Bacterial Conjunctivitis (emDOCs)
- Acute or chronic inflammation of the eyelid margins, most commonly caused by dysfunctional meibomian gland or staph infection
- Further divided into anterior and posterior blepharitis
- Itchy/sore, tearing, blurry vision
- Crusting at lid margins, eye flaking, red-rimming of eyelid
- Slit-lamp exam
- Warm compresses, irrigation, massage
- Topical antibiotics (ex. erythromycin, bacitracin) if infection suspected
*Deep Dive: Blepharitis (Merck Manual)
Corneal Foreign Body
- Foreign material that becomes embedded on or in the corneal epithelium.
- Commonly caused by grinding or hammering metal w/o eye protection.
- Eye pain, tearing, foreign body sensation, blurred/decreased vision (rare)
- (+) Seidel sign; suggests corneal perforation
- Slit lamp or X-ray
- Topical anesthetic, irrigation/cotton-swab
- Deep foreign bodies and rust rings may require removal by ophthalmologist
*Deep Dive: Ocular Foreign Body (WikEM)
- Full thickness corneal/scleral injury, causing compromise to the globe.
- Occurs when blunt or penetrating force is applied to the eye, causing an abrupt rise in intraocular pressure. This is a vision threatening emergency
- Eye pain, tearing, limited extraocular movements, hyphema, extrusion of intraocular contents, teardrop-shaped pupil
- Clinical diagnosis; CT can may help identify fractures or foreign bodies
- Do NOT perform tonometry (may worsen injury)
- Minimize intraocular pressure (pain control, nausea/vomiting control, antitussives, elevate head of bed). Update tetanus.
- Emergent ophthalmologic consultation for surgical management
*Deep Dive: Globe Rupture (WikEM)
- Infection of the orbital tissues behind the eye. Most often a complication of sinusitis, but can also occur from orbital trauma or tooth/ear infections.
- Most often affects children ages 7-12 years of age
- Limited extraocular movement, proptosis, painful eye movements, fever
- Mostly clinical
- CT scan of orbits can confirm diagnosis
- Broad-spectrum antibiotics (ex. Vancomycin + Zosyn)
- Consult ophthalmology. May require surgical drainage.
*Deep Dive: Orbital Cellulitis (emDOCs)