A 22-year-old woman comes to the urgent care clinic with a painful, gritty sensation in her right eye, eyelid swelling, and photophobia for the past 2 days. She has been studying for college exams and initially attributed her symptoms to fatigue. The patient wears contact lenses for myopia but has been using glasses since this morning.
Physical examination shows conjunctival injection and upper eyelid swelling. Fluorescein staining shows a 6-mm corneal defect. Visual acuity is normal bilaterally.
Which of the following is the best next step in management of this patient?

Question

A 22-year-old woman comes to the urgent care clinic with a painful, gritty sensation in her right eye, eyelid swelling, and photophobia for the past 2 days.  She has been studying for college exams and initially attributed her symptoms to fatigue.  The patient wears contact lenses for myopia but has been using glasses since this morning.
Physical examination shows conjunctival injection and upper eyelid swelling.  Fluorescein staining shows a 6-mm corneal defect.  Visual acuity is normal bilaterally.
Which of the following is the best next step in management of this patient?

Quizplus · Accepted Answer

11ec193a_989c_c06b_853d_d390e08d35d7_MD0002_00 Bacterial keratitis (BK) is the most common infectious complication of contact lens use, especially in patients who use extended-wear or overnight lenses. Symptoms include pain, eyelid swelling, photophobia, and conjunctival injection. If the corneal lesion (visible under fluorescein staining) is central, vision may also be affected. An inflammatory infiltrate (hypopyon) is occasionally seen in the anterior chamber. The diagnosis of BK is primarily clinical. Treatment with empiric, broad-spectrum topical antibiotics (with Pseudomonas coverage) such as the fluoroquionolone gatifloxacin should be initiated; erythromycin would not provide appropriate coverage (Choice D). Culture (via corneal scrapings) or impression cytology is helpful in severe infections or those that fail to respond to initial antibiotic treatment (Choice B). Antibiotics should be applied hourly for the first 24-48 hours, and concomitant corticosteroids should be avoided in the acute phase (Choice C). (Choice A) Eye patching should be avoided in BK as it can create a warm, moist environment favorable to further bacterial growth. Educational objective: Bacterial keratitis is the most common infectious complication of contact lens use. Symptoms include pain, eyelid swelling, photophobia, and conjunctival injection. Empiric treatment with broad-spectrum topical antibiotics is advised. __________ References: Fluoroquinolones or fortified antibiotics for treating bacterial keratitis: systematic review and meta-analysis of comparative studies. (http://www.ncbi.nlm.nih.gov/pubmed/23217502) Corneal erosions in contact lens wear. (http://www.ncbi.nlm.nih.gov/pubmed/21816659)

A 22-Year-Old Woman Comes to the Urgent Care Clinic with a Painful