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accompanied by a discharge. Increasing pain and photophobia are usually present with a
developing corneal ulcer.
A traumatic corneal abrasion is treated with gatifloxacin 0.3% drops or
moxifloxacin 0.5% drops four times a day to prevent infection. Diclofenac 0.1% drops
four times a day may be added for pain control. (Wait 5 minutes between drops.)
Sunglasses are helpful in reducing irritation from light if the eye is not patched. Patching
of abrasions is no longer routinely done, but is an option for very large abrasions or if the
individual gets significant pain relief from the patch. If the eye is patched because of a
large or very painful abrasion, use bacitracin ointment before patching and recheck the
eye in 24 hours. Depth perception will be affected by patching, so the individual will
need to use care if he or she is moving across the terrain in a wilderness setting not to
incur a secondary injury from a fall. Scopolamine 0.25%, 1 drop bid or before patching,
may be added for very painful abrasions, but will result in blurring of near vision and a
dilated pupil for 3-6 days. Systemic analgesics may also be required in some cases.
Remove the patch daily to check for the development of a corneal ulcer and to repeat the
fluorescein stain to monitor healing. Healing of the abrasion should occur within 1-3
days. If the trauma causing the abrasion is related to contact lens wear or insertion, there
is a higher incidence of secondary infection with gram negative organisms and the eye
should NOT be patched. Use gatifloxacin 0.3% drops or moxifloxacin 0.5% drops every
2 hours while awake until the abrasion is healed and watch the eye closely for
development of a corneal ulcer.
If the diagnosis of corneal ulcer is made on the basis of trauma, an epithelial
defect, and a white or gray spot on the cornea, treat with gatifloxacin 0.3% drops or
moxifloxacin 0.5% drops as follows: 1 drop every 5 minutes for 5 doses; 1 drop every 30
minutes for 6 hours; then 1 drop every hour around the clock. Scopolamine 0.25% may
be added for pain control if needed. A corneal ulcer is a vision-threatening disorder that
may progress rapidly despite therapy, so an expedited evacuation should be arranged.
A post-traumatic red eye without an obvious open globe or an epithelial defect on
fluorescein staining may represent a subconjunctival hemorrhage, traumatic iritis,
hyphema, or an occult ruptured globe. A subconjunctival hemorrhage is a bright red area
of blood overlying the sclera of the eye. It requires no treatment, but a careful inspection
of the eye for associated injuries should be made. If the subconjunctival hemorrhage is
massive and causes outward bulging of the conjunctiva (called chemosis), then suspect an
occult ruptured globe and manage as described above for an obvious open globe.
Blood in the anterior chamber of the eye is called a hyphema. The primary
concerns in this disorder are associated globe rupture and increased pressure in the eye.
Urgently evacuate these individuals. Place a protective shield over the eye. Restrict
activity to walking only. Do not let these individuals read. Do not treat them with
NSAIDs or aspirin because of the increased risk of bleeding.
Traumatic iritis may follow blunt trauma to the globe or a corneal abrasion. Keys
to diagnosis are pain and photophobia following blunt trauma or after a corneal abrasion
has healed. Traumatic iritis typically resolves without treatment in several days, but
severe cases may be treated with topical prednisolone 1% drops four times a day for three
days. Although topical steroids should not generally be prescribed except by
ophthalmologists, use of prednisolone drops will probably not cause any significant
