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twice a day. The patient requires urgent evacuation. If improvement is not seen within
24-48 hours and evacuation has not been possible, start prednisone 80 mg once a day and
continue until evacuation to definitive care is accomplished.
If the patient has no history of trauma, no epithelial defect or dendrites on fluorescein
staining, and there is either no eye pain or the pain IS significantly relieved by topical
anesthesia, then the likely diagnosis is one of the disorders discussed below.
Conjunctivitis: Conjunctivitis is recognized by an acute onset, the presence of a ocular
discharge, exposure to other persons with eye infections, and/or URI symptoms. Treat
with gatifloxacin 0.3% drops or moxifloxacin 0.5% drops 1 drop four times a day for 5
days. Caution the affected individual about possible spread of the infection to the other
eye as well as to other individuals. Note that many cases of conjunctivitis are of viral
etiology and do not respond to antibiotics. Topical antibiotics should usually not be given
for more than 5 days.
Blepharitis: This condition is often chronic with a history of previous exacerbations and
remissions. It is more common in older individuals and is usually bilateral, although one
eye may be more severely affected than the other. Treatment is with bacitracin ointment
applied to the lid margins once a day at bedtime for 3-4 weeks. One week of four times a
day application may be helpful in more severe cases. In addition, warm compresses used
for 10 minutes two to four times a day followed by gentle wiping away of the
inflammatory material on the eyelashes is beneficial.
Ultraviolet Keratitis: The diagnosis of UV keratitis, also known as snowblindness, is
usually easy to make in the presence of bilateral eye pain and a sunburned face. As with
sunburn of the skin, the symptoms do not reach their maximum intensity until several
hours or longer after the exposure, so it is common for these patients to present in the
evening hours. Fluorescein staining typically reveals no frank epithelial defect, but
numerous small dots of stain uptake called superficial punctate keratitis or SPK.
Treatment is with gatifloxacin/moxifloxacin drops four times a day until signs and
symptoms resolve. These individuals are usually very photophobic and sunglasses are
helpful. Patch severely affected eyes for comfort, although it is usually better to avoid
patching both eyes if possible, for obvious reasons. Scopolamine 0.25%, 1 drop twice a
day, may be helpful in relieving pain if the discomfort merits the blurred vision and
dilated pupil that scopolamine therapy entails. Systemic analgesia may be required.
Monitor these individuals daily until epithelial staining resolves to ensure that they do not
develop a corneal ulcer.
Foreign material in eye: Although the abrupt onset of a foreign body sensation is strongly
suggestive, definitive diagnosis requires identification of the foreign material, which may
sometimes be quite difficult. Treatment consists of location and removal of the foreign
body using enhanced lighting and magnification. Topical anesthesia will make the patient
much more comfortable during the search and removal efforts, although it may be helpful
to have the patient identify the general location of the foreign material before applying
topical anesthesia. Use a hand-held magnifying lens or pair of reading glasses to aid in
