Cornea
Corneal Ulcer (microbial keratitis)
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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.
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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
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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
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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
Date reviewed 07/08/2019
Next review due 07/08/2020
Sifter name Dr Rebecca Harling
Contributor Mr William Westlake
Version No. 3.10