Research in patient's Diagnosis

Velasquez, Aaron Kim B. BSN 103 A (new) Mrs. Ma. Corazon Sibal

Corneal laceration A corneal laceration is cut on the cornea, the clear front window of the eye. It is usually caused by something sharp flying into the eye or something striking the eye with significant force, like a metallic hand tool. A corneal laceration is deeper than a corneal abrasion, cutting partially or fully through the cornea. If the corneal laceration is deep enough (called a full thickness laceration), it will cut completely through the cornea and cause a ruptured globe, a tear in the outer surface of the eyeball itself. A corneal laceration is a very serious injury and requires immediate medical attention to avoid severe vision loss. Causes Any activity in which objects can fly into the eye at high speed can cause a corneal laceration. Among the most common causes of a corneal laceration are such activities as cutting wood, grinding metal, trimming grass or carving stone. Contact with dust, dirt, sand, or even an edge of a piece of paper can possibly cut the cornea if enough force is involved. Diagnosis To examine your corneal laceration, your Eye M.D. may put numbing drops in your eye so that it can stay open for the exam. He or she may also perform a fluorescein eye stain. This is a test that uses orange dye (fluorescein) and a blue light to detect damage to the cornea. Imaging Studies Radiography, CT, or MRI may be indicated to locate intraocular or intraorbital foreign bodies Eye drops to help stop the muscle spasms and relieve the pain and sensitivity to light is available, but has the side effect of blurred vision. You may or may not get the eye patched. Recent evidence has shown that an eye patch really doesn't help aid healing and may have a negative impact in the healing process. So if your doctor chooses to place a patch, just ask why, because he or she may have a very specific reason for doing so.

You may need to have a tetanus booster if yours is not up to date. Wearing sunglasses may help relieve the pain and you might be prescribed pain pills. Be sure to take them as directed. Prevention To prevent corneal abrasions wear protective eyewear when participating in certain sports such as racquetball, when in situations where objects could fly into your eyes, such as working with wood or metal. Also wear sunglasses when skiing to block the UV radiation. The sunlight reflecting off the snow combined with direct sunlight can cause corneal flash burns. If your eye has been injured, you should do the following: Gently place a shield over the eye. The bottom of a paper cup taped to

the bones surrounding the eye can serve as a shield until you get medical attention. DO NOT rinse with water. DO NOT remove the object stuck in eye. DO NOT rub or apply pressure to eye. Avoid giving aspirin, ibuprofen or other non-steroidal, anti-inflammatory After you have finished protecting the eye, see a physician immediately.

drugs. These drugs thin the blood and may increase bleeding.

Treatment Surgery is usually necessary to repair a corneal laceration and to prevent further damage to the eye, as well as to remove any foreign object that may have remained in the eye after the trauma. Severe lacerations can require several surgeries for repair and can result in permanent vision loss. Following surgery, your eye may be patched to protect it. In addition, your ophthalmologist may provide you with medications, including medication for pain, to help you to heal.

If you have a corneal laceration, you may be at risk for complications, including retinal detachment, infection and glaucoma. It is important that you follow up with your ophthalmologist for care after your immediate treatment. Medications Recommendations include a combination of a cephalosporin (eg, cefazolin) or vancomycin and an aminoglycoside (eg, gentamicin). In addition, add clindamycin if an intraocular foreign body is present or if vegetable matter has contaminated the wound. The most common organisms identified in posttraumatic endophthalmitis are Staphylococcus epidermidis, bacilli species, streptococci species, and gram-negative species. Fungal endophthalmitis is a relatively rare entity but should be considered in a patient who is recently post-surgical, immunocompromised, unresponsive to antibiotic treatment, or has a history of trauma with vegetable matter. Treatment should be discussed with the ophthalmology consultant if this is suspected.

Endophthalmitis is an inflammatory condition of the intraocular cavities (ie, the aqueous or vitreous humor) usually caused by infection. Noninfectious (sterile) endophthalmitis may result from various causes such as retained native lens material after an operation or from toxic agents. Panophthalmitis is inflammation of all coats of the eye including intraocular structures. The 2 types of endophthalmitis are endogenous (ie, metastatic) and exogenous. Endogenous endophthalmitis results from the hematogenous spread of organisms from a distant source of infection (eg, endocarditis). Exogenous endophthalmitis results from direct inoculation as a complication of ocular surgery, foreign bodies, and/or blunt or penetrating ocular trauma. Under normal circumstances, the blood-ocular barrier provides a natural resistance against invading organisms. In endogenous endophthalmitis, blood-borne organisms (seen in patients who are bacteremic in situations such as endocarditis) permeate the bloodocular barrier either by direct invasion (eg, septic emboli) or by changes in vascular endothelium caused by substrates released during infection. Destruction of intraocular tissues may be due to direct invasion by the organism and/or from inflammatory mediators of the immune response. Causes In most clinical series, gram-positive organisms are the most common causative organisms of endophthalmitis. The most common organisms are coagulase-negative Staphylococcus epidermidis, Staphylococcus aureus,and Streptococcus species. Gram-negative organisms like Pseudomonas, Escherichia coli, and Enterococcus are observed in penetrating injuries. Signs and symptoms A history of recent intraocular surgery or penetrating ocular trauma is usually elicited. In some cases of metastatic endophthalmitis, the spread of infection may be hematogenous (via the bloodstream). That is more commonly seen in patients with immunocompromised states like AIDS and also in diabetes. The condition is usually accompanied by severe pain, loss of vision and redness of the conjunctiva and the underlying episclera. Alongside are present signs of inflammation of the various coats of the eye. Diagnosis The doctor will review your symptoms. He or she will ask about your medical history, especially any eye surgery or eye trauma.

The doctor will examine your eyes. He or she will test how well you see in both eyes. The doctor will use an ophthalmoscope. This is a lighted instrument for looking inside the eye. An ultrasound of the eye may be ordered. Ultrasound can detect abnormal debris in the center of the eye. The ophthalmologist may recommend a procedure called a vitreous tap. The doctor anesthetizes the eye. He or she then uses a tiny needle to withdraw some of the eye's internal fluid. This fluid is tested for bacteria or other organisms.

Prevention To prevent endophthalmitis caused by eye trauma, use protective eyewear at work and during contact sports. Goggles, eye shields and helmets can help protect against industrial debris that can pierce or cut the eyes.

Treatment The patient needs urgent examination by an expert ophthalmologist and/or vitreo-retina specialist who will usually decide for urgent intervention to provide intravitreal injection of potent antibiotics and also prepare for an urgent pars plana vitrectomy as needed. Enucleationmay be required to remove a blind and painful eye.

Medications Vancomycin has been shown effective against greater than 99% of gram-positive endophthalmitis isolates.

The aminoglycoside amikacin (0.4 mg in 0.1 mL) is useful for gramnegative coverage. Approximately 90% of gram-negative isolates are susceptible to this agent.

Ceftazidime demonstrates similar gram-negative sensitivity profiles as the aminoglycosides and is not associated with retinal toxicity. Therefore, ceftazidime is a reasonable alternative for gram-negative coverage.

The use of intravitreal dexamethasone in the treatment of acute postoperative endophthalmitis remains controversial. Clinicians have used this short-acting corticosteroid to inhibit the inflammatory effects of bacterial endotoxins, host factors, and antibiotics. In a rabbit model of

virulent infectious endophthalmitis, dexamethasone was shown to decrease elimination of intraocular vancomycin through the trabecular meshwork, suggesting a new potential benefit to steroid administration.