Corneal Ulcer in contact lense wearer

[waterski232002]

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What drops do you guys use for contact lense wearers who develop corneal ulcers? Do you double cover pseudomonas? I personally have never heard of double coverage in regards to corneal ulcers, but someone mentioned it to me.

 

[southerndoc]

What drops do you guys use for contact lense wearers who develop corneal ulcers? Do you double cover pseudomonas? I personally have never heard of double coverage in regards to corneal ulcers, but someone mentioned it to me.

I usually give them sulfacetamide or gentamicin drops since we have a large stock of them in our ED. If I'm worried about Pseudomonas, I'll give them a script for ciprofloxacin eye drops with instructions to fill it if they are not better within 24 hours.

I really like sulfacetamide drops, but they do sting.

 

[kungfufishing]

cipro drops

 

[DrQuinn]

cipro or tobra

Q

 

[deleted109597]

Any corneal abrasion should also get a tetanus shot.

 

[Hayduke]

why?

 

[bartleby]

Somebody needs to point that the original poster said "corneal ulcer" not "abrasion". A corneal ulcer in a contact lens wearer is BAD NEWS. These deserve a) followup within 24 hours and b) mandatory coverage with broad spectrum abx which include activity against pseudomonas (most contact lens wearers are colonized). Many feel that any corneal abrasion in a contact lens wearer shouldn't be covered by anything less than tobramycin. They must be read the riot act about not wearing their lenses until told otherwise by ophtho. If an ulcer progresses, they can perf their globe... bad news. Many ophthalmologists prefer vigamox over cipro (better gram positive coverage), but if your patient can pay for neither and you have cipro in your pyxis, you've already got your answer.

 

[waterski232002]

so.... sounds like nobody else over here has ever "double covered" for pseudomonas in corneal ulcers... single coverage with Tobra, Cipro, etc is what I have been doing also.

 

[deleted109597]

why?

# Tetanus immunization
#

* Tetanus associated with corneal injuries may rarely occur. Follow the Centers for Disease Control and Prevention (CDC) guidelines for tetanus toxoid (Td for adults, DT for children <7 y) and tetanus immunoglobulin (TIG).
*
* Corneal injuries produced by organic matter or dirt, as well as those associated with tissue necrosis and those associated with entrance of dirt or organic material into the conjunctival sac, should be considered dirty (ie, tetanus-prone) injuries and require boosters within 5 years.
*
* Corneal injuries caused by metallic foreign bodies associated with minimal tissue destruction should be considered clean (ie, non–tetanus-prone) injuries and require boosters within 10 years. (As of January 2005, no case reports in the literature indicate clinical tetanus developing from a simple corneal abrasion.)
From eMedicine, but I learned it from 5MCC I think.