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.
Review common otic disorders and appropriate drug and nondrug therapies.
This chapter provides an overview of common ophthalmic and otic disorders and their treatments. 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. Healthcare professionals should also be aware of common otic disorders that may be encountered.
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 63–1).
Table 63–1Ophthalmic Emergencies: Time to Follow Up by Ophthalmologist ||Download (.pdf) Table 63–1 Ophthalmic Emergencies: Time to Follow Up by Ophthalmologist
|Immediate Consult Required ||Within 24 Hours |
|Acute chemical burn ||Acute angle-closure glaucoma |
|Acute, painless loss of vision ||Blood in the eye (hyphema) |
|Blunt trauma to eye ||Corneal ulcer |
|Foreign body in eye ||Macular edema |
|Orbital cellulitis ||Sudden congestive proptosis (bulging of eye forward) |
|Retinal detachment || |
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, also called corneal epithelial defects, heal quickly—typically within 24 hours.4 Moderate abrasions take 24 to 72 hours to heal. Deep abrasions may scar the cornea. This rarely results in sufficient visual impairment to require corneal transplant. Patients should be instructed not to rub the eye if a corneal abrasion is present. Do not use eye patches to treat uncomplicated corneal abrasion.3...