A teenage boy presented to clinic with a red, painful, angry eye with significant loss of vision after a rock flew into the eye while weed whacking without safety glasses. The patient had been to the Emergency Department 5 days earlier where they prescribed him Ciprofloxacin ophthalmic drops 8 times a day for a "corneal abrasion". While the abrasion was highly likely, such a severe injury and significant loss of vision should have been seen by an eye specialist much sooner. Thankfully with appropriate management we were able to gradually improve the condition, reduce the iop, and regain much vision. However there were some sequelae that will serve as a lasting reminder to always wear safety glasses.
Pt using ciprofloxacin antibiotic drops 8 times a day given by the emergency department for "corneal abrasion" since day of event (5 days prior). Not noticing improvement. Noticing decrease in vision.
Started on Acetazolamide ER tablets twice daily, Dorz/tim drops QID, and Pred Acetate QID. RTC x 1 day.
All findings were similar other than iop lowered OD. Attempted posterior view with fundus photos, hazy view revealed no obvious issues in back of eye. Pt still in pain throughout night and day, still sensitive to light. Difficult examination due to photophobia.
Continue Acetazolamide and Dorz/tim as Rx'ed, increase Pred Acetate to 5-6x/day. RTC x 1 day.
Vision began to return, pt able to make out shapes. Pain and symptoms still persist. IOP remains stable, cornea PEEs cleared and swelling reduced. Bulbar conjunctiva is not as injected as previously. Attempted to obtain gonio view, but was unable.
Continue Acetazolamide and Dorz/tim as Rx'ed, increase Pred Acetate to 5-6x/day.
Patient notes steady improvement to vision, pain, redness, and photophobia. Corneal haze and swelling also improving and iop remaining low and stable. Still unable to obtain gonio views today, was able to confirm a healthy and normal p-seg through 90 D lens.
Discontinue Acetazolamide, continue Dorz/tim and Pred Acetate as Rx'ed. RTC x 1 day to confirm OD iop has remained low off Acetazolamide.
Symptoms noted to still persist, Vision improves and iop remains WNL off Acetazolamide. Traumatic cataract is confirmed and discussed with patient and mother. Will not be able to determine the extent of vision detriment until inflammation continues to subside.
Reduce Dorz/tim to BID and continue Pred Acetate 6x/day. RTC x 3 days for fu.
Patient notes improvement to symptoms, has redness and some lingering pain, but is able to keep eye open now. OD iris is still fixed and dilated, suspecting potential synechiae, will be confirmed or denied as inflammation subsides.
Discontinue Dorz/tim, continue Pred Acetate 6x/day. RTC x 10 days for fu. If cell improves then consider taper.