Upon completion of the chapter, the reader will be able to:
Differentiate between the various ophthalmic disorders based on patient-specific information.
Choose an appropriate treatment regimen for an ophthalmic disorder.
Discuss the product differences that direct the selection of ophthalmic medications.
Assess when further treatment is required based on patient-specific information.
Recommend an ophthalmic monitoring plan given patient-specific information, a diagnosis, and a treatment regimen.
Educate patients about ophthalmic disease states and appropriate drug and nondrug therapies.
This chapter provides an overview of common ophthalmic disorders and their treatments. KEY CONCEPT Many ophthalmic disorders are benign or self-limited, but the clinician must be able to distinguish conditions that lead to serious morbidity, including blindness. Preserving both visual function and cosmetic appearance is the goal.1 The clinician must understand when referral is appropriate and the proper time frame for follow-up, based on the patient-specific condition.
Etiology and Epidemiology
Ophthalmic problems encompass 3% of all emergency department visits.2 Corneal abrasions are the most common eye injury in children. Scratches, objects and aggressive eye rubbing may damage the cornea.3 Healthcare practitioners must know the proper treatment for ocular emergencies and the time frame for follow-up in order to prevent further morbidity (Table 62–1).
Table 62–1Ophthalmic Emergencies: Time to Follow Up by Ophthalmologist |Favorite Table|Download (.pdf) Table 62–1Ophthalmic Emergencies: Time to Follow Up by Ophthalmologist
|Immediate Consult Required ||Within 24 Hours |
|Foreign body in eye ||Acute angle-closure glaucoma |
|Acute, painless loss of vision ||Orbital cellulitis |
|Acute chemical burn ||Blood in the eye (hyphema) |
|Blunt trauma to eye ||Macular edema |
| ||Retinal detachment |
| ||Sudden congestive proptosis (bulging of eye forward) |
| ||Corneal ulcer |
| ||Corneal abrasion |
Complete healing of the corneal abrasion with no scarring or vision impairment
Prevent infection and pain
Prevent corneal loss or corneal transplant
General Approach to Treatment
The five layers of the cornea contain no blood vessels but are nourished by tears, oxygen, and aqueous humor. Minor corneal abrasions heal quickly. Moderate abrasions take 24 to 72 hours to heal. Deep scratches may scar the cornea and require corneal transplant if vision is impaired. Do not use eye patches to treat uncomplicated corneal abrasion.3
Corneal Abrasion Prevention3
Wear eye protection during sports
Wear industrial safety lenses
Carefully fit and place contact lenses
Topical NSAIDs Topical nonsteroidal anti-inflammatory drugs (NSAIDs) decrease pain from corneal abrasion. Available ocular NSAIDs are bromfenac 0.09%, ...