201021U. S. Special Operations Command (USSOCOM)

CORNEAL ABRASIONS/ CORNEAL ULCERS/ CONJUNCTIVITIS
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 LASIK surgery.
SIGNS AND SYMPTOMS:
1. History of eye trauma or contact lens wear
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. Remove contact lens if worn.
2. Tetracaine 0.5%, 2 drops in the affected eye for pain relief. Do not dispense to patient.
3. Check for foreign body to include eyelid eversion. Irrigate with normal saline prn.
4. Gatifloxacin (Zymar) 0.3% drops – 1 drop in the affected eye qid while awake.
5. Treat per Pain Management Protocol.
6. Reduce light exposure, stay indoors if possible - sunglasses if not possible.
7. For corneal abrasions: monitor daily for worsening signs and symptoms of a corneal ulcer (increasing
pain and development of a white or grey spot at abrasion site). DO NOT PATCH.
8. Assess using fluorescein drops daily — abrasions should get progressively smaller. Continue
antibiotic drops until 24 hours after cornea becomes fluorescein negative (no bright yellow spot).
9. IF CORNEAL ULCER PRESENT: Increase Gatifloxacin (Zymar) drops to q 2h and Priority
evacuation.
DISPOSITION:
1. Evacuation may not be needed for corneal abrasion if improving with treatment.
2. Priority evacuation for Corneal Ulcer
3. Urgent evacuation for LASIK flap dislocation.
Winter 2010 Training Supplement TMEPS
A29