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Cornea

Corneal Ulcer (microbial keratitis)

  • Bacterial
    • Remove contact lens
    • Save lens & case as maybe useful for culture
    • Usually refer to eye casualty before antibiotics, for corneal scrape – must if loss of vision, corneal opacity, thinning, or severe symptoms
    • If very mild at presentation consider hourly chloramphenicol ointment, refer to eye casualty if doesn’t respond.
  • Dendritic (herpetic)
    • Ointment acyclovir 5X,
    • refer eye casualty unless mild and resolving

 

Corneal erosion/abrasion

Management

  • Exclude subtarsal FB
  • Remove corneal FB
  • Chloramphenicol ointment and mydriasis
  • Pad may help symptoms, but not speed up healing.
  • Recurrent erosion – copious lubricants and lubricant ointment at night for 3 months

When to refer

  • Refer to eye casualty if high velocity injury, suspect perforation, persistent rust ring and symptoms

 

Keratoconus

  • Where to refer
    • Refer routine to the corneal consultant at RCHT clinic for corneal topography and formal diagnosis.  Once diagnosed, hospital eye service can support funding of contact lenses, fitted by community optometrists
    • Re-refer when intolerant of contact lens and needs surgery

 

Pinguecula/pterygium

  • Management
    • If inflamed lubrication and topical NSAID
  • When to refer
    • Refer as routine if significant growth across limbus and severe symptoms warranting surgery usually lamellar keratectomy and conjunctival graft