Page 214 - ATP-P 11th Ed

CORNEAL ABRASIONS /
CORNEAL ULCERS / CONJUNCTIVITIS PROTOCOL

SPECIAL CONSIDERATIONS
1. Contact lens corneal abrasions are at a high risk for development of a corneal
ulcer. They should not be patched and require more intensive antibiotic therapy.
2. Consider LASIK flap dislocation for anyone that sustains eye trauma after
SECTION 2 3. If vesicant (sulfur mustard) exposure, onset of symptoms <12 hours from expo-
LASIK surgery.
sure indicates moderate to severe exposure.

Signs and Symptoms
1. History of eye trauma, contact lens wear, or chemical exposure.
2. Eye pain – typically becoming worse over several days
3. Eye redness
4. Tearing
5. Blurred vision
6. Light sensitivity
7. Fluorescein stain positive
8. White or gray spot on cornea for corneal ulcer (usually need tangential penlight exam
to see).
9. For sudden onset of eye pain after trauma in a patient with LASIK surgery, consider
LASIK flap dislocation.
Management
1. If chemical exposure, immediately irrigate with large volume of water.
2. Remove contact lens(es) if worn.
3. Tetracaine 0.5%, 2 drops in the affected eye for pain relief. Do not dispense to
patient.
4. Check for foreign body to include eyelid eversion. Irrigate with normal saline prn.
5. Gatifloxacin (Zymar ) 0.3% drops – Corneal Abrasion: 1 drop in the affected eye
®
qid while awake for corneal abrasion. Corneal Ulcer: culture if possible prior to treat-
ment then start gatifloxacin 1 drop q15min × 2hr, then q1hr during the day and q2hr
through the night.
6. Treat per Pain Management Protocol.
7. Reduce light exposure, stay indoors if possible – sunglasses if not possible.

204 SECTION 2 TACTICAL MEDICAL EMERGENCY PROTOCOLS (TMEPs) ATP-P Handbook 11th Edition 205