All posts with tag: "ophtho"

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You are seeing a 9 year old African-American child who was hit in the eye with a baseball. On exam there is visible blood layering in the anterior chamber, filling approximately 50% of the anterior chamber. There is no evidence of an open globe injury. 

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You are seeing a 10 day old ex-full term infant with bilateral watery mucoid eye discharge, mild eyelid edema, and papillary conjunctivitis. You suspect chlamydial conjunctivitis. What is the best management?

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(Click the link to comment and to vote - voting not working through email, sorry!) You are seeing a 13 year old girl with 2 days of left eye redness and pain, and 1 day of fever. She recently got a new kitten and had been having itchy eyes and nasal congestion for the last 2 weeks. Her temperature is 38.3, HR 90, RR 20, BP 110/60, O2 sat 99% on room air. She is alert, has no nuchal rigidity, and is not toxic appearing. She has left periorbital edema and erythema but her eye can be manually opened. She is PERRL, has no chemosis or proptosis, and has mild conjunctival injection but no discharge. Her extraocular movements are full, but she complains of pain with extraocular movements. Her vision is 20/20 on the right and 20/60 on the left. [yop_poll id="154"]

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(Click the link to comment and to vote - voting not working through email, sorry!) A 16yo boy presents with chief complaint of a black “hole” in the center of his vision in his right eye 4 days after being hit by a baseball to the eye. He has periorbital ecchymosis but no evidence of orbital fracture. Visual acuity is 20/60 on right, 20/20 on left. He is PERRL, EOMI without pain, and has normal IOP and slit lamp exam. Fundoscopic shows a deep subretinal hemorrhage in his macular area with a small curvilinear yellow line visible. [yop_poll id="109"]

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(Click the link to comment and to vote - voting not working through email, sorry!) www.jems.com A 2 year old toddler comes in from the playground crying and rubbing at his right eye. Exam is as above. [yop_poll id="33"]

For children who have difficulty allowing the caretaker to administer eye drops, have them lay flat and close their eyes. Place several drops in the medial corner of the eye – when they open their eye, the drops will seep in. If a caretaker is going to use this technique, be sure to prescribe extra volume of medication. This method is shown ~0.42 in this video, which is a useful video overall showing several techniques.

Following up on last month's tips regarding antibiotic eye drops, it's helpful to know that the color of the eye drop bottle cap tells you the medication class of the contents!

When treating run of the mill bacterial conjunctivitis, I was taught to use erythromycin ointment for young infants that are not yet walking, and polytrim drops for older kids. The ointment is nice in that it sticks in the eyes better, but it can be annoying to have goopy eyes for an ambulatory toddler. This is a nice summary from an ophthalmologist / comedian. In particular, as he states, stay away from gentamicin and sulfas - they often cause eye irritation. It can be hard to differentiate viral from bacterial conjunctivitis, and in the spirit of "first do no harm," you don't want to worsen the symptoms of a viral conjunctivitis that was going to self-resolve anyways.

Use a sterile saline respiratory ampule: wet the fluorescein strip with the saline, squeeze out half of the saline, then suck the yellow fluorescein liquid back up into the ampule. Now you can use the ampule as an eyedropper. For uncooperative kids, lay them supine and squeeze the liquid into the medial corner of the closed eye - when they open their eyes it will run into the eye.  (Amazon.com) For additional methods, see AliEM's great tricks of the trade post at: https://www.aliem.com/2015/tricks-of-the-trade-fluorescein-eye/

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Note: controversies are not meant to have a “right” answer – they are to see how most people are practicing. Would love your comments also regarding your thought processes and the evidence behind your decisions. We can learn from each other!

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