Best way to check VA thru ointment

[scograd]

hi all,
What's the best way to check VA when your patient still has a lot of residual and ointment while txing a corneal abrasion?

I have a patient who came in with 20/40 uncorrected, with a corneal abrasion that covered about 60% of the cornea. Luckily, it only went through the very superior part of the visual axis.

We're now at about 75% resolution with a bit of the vis axis still involved. Problem is, all I can get uncorrected is 20/100, but it seems mostly due to the erythromycin ointment blurring the vision as well as a lot of lacrimation still.

I'm happy with the rate of resolution and the fact that there hasn't been any ant chamber inflammation. But I am a little concerned with the acuity. This is the largest abrasion that I have managed, so I just want to see if I am on par for the course.

[npdr]

The vision is just one of the parameters that are used in an abrasion. I don't get worried about any kind of visual acuity until the abrasion or keratitis has disappeared.

If I still see keratitis of significant amount, after three to four days, then I don't believe the diagnosis is abrasion. Instead, I might think it is recurrent corneal erosion. Ointment should not cause keratitis. If the there us ointment and there is no keratitis, then you can discontinue the ointment and check vision the next day.

[chip anderson]

There is an age old technique in medicine, now that O.D.'s are practicing medicine you should learn it. Wait and see.

[Dave Nelson]

I usually do a quick check with a keratometer and see if the mires are distorted and/or muddy. Under those circumstances they usually are, and significant central distortion could account for the acuity. Things will probably settle down in a couple days.

[npdr]

There is an age old technique in medicine, now that O.D.'s are practicing medicine you should learn it. Wait and see.

chip anderson,

You amaze me. This started as a pretty mild subject matter. And you have to inject this. What is it with you?

Are you just always like this or just to optometrists?

[chip anderson]

It's good sound advise and a rather elemental question for an expert trained professional to be asking.

Anyone knows not to prescribe anything for an injured eye unless the patient has nothing to see with and is non-functional without same.

Kind of like when I see an article where the "expert" has just discovered rigid lenses and wants to share his expertise with everyone else.

Chip

[npdr]

Now, if you said that the first time, everyone would read it and smile. Thanks for lessening the tone.

[Dave Nelson]

I also support the use of broad spectrum antibiotics in cases of large abrasions, depending on the severity and ORIGIN of the abrasion. I recall a case where I was involved with a bandage lens. The abrasion had an animal origin, (the pad of a dogs paw.) There were no antibiotics prescibed by an emergency room physician, so by the time Ophthalmology got involved, the cornea infected, and we watched in horror as it spread to the interior ocular structures. An eviseration was the final result, and it was all I could do to keep from telling her flat out to file a complaint and/or lawsuit against the ER doc.

[snowmonster]

I'm curious why you wouldn't apply a high-dK lens (Oasys, for example) with frequent monotherapy dosing of Zymar or Vigamox (aside from any allergy situations)? I've never seen an abrasion head south with such therapy.

[orangezero]

Anyone knows not to prescribe anything for an injured eye unless the patient has nothing to see with and is non-functional without same.

Chip

I'm still not sure I understand your point, Chip. What are you suggesting he/she not prescribe?

[chip anderson]

Spectacles, contact lenses, intraocular lenses, RK surgery, Lasic, anything to correct or evaluate vision.
Even determining acutity beyond light preception is more or less useless during the healing process.

[Dave Nelson]

By the time I saw the patient, the infection had started. She saw me again early the next morning, had significant blood in the anterior chamber, and I referred her back to the ophthalmologist immediatly, although she was scheduled to see him later the same day. I felt hospital admission was indicated, but by then agressive antibiotic therapy was ineffective. I don't know if culture and sensitivity was done, or if any IV antibiotics were initiated, but next time I saw the patient, She was 24 hours post-op, and planning a visit to the ocularist. I have a limited knowlege of ocular TPAs, but even I know a corneal abrasion from an animal source requires both antibiotics and close observation.

[bblaker]

I have to agree with snowmaster if your VA is of concern DX ointment, which is of no significant use, put pt in O2 optiks RX zymar qid to q1h check VA in the am, but as long as its not getting worse, its getting better....and chip isnt to far off just wait and see....

[npdr]

Dear bblaker,

In your opinion, could you please relate the rationale for a bandage soft contact lens (BSCL) for the OP's eye patient?

[Oedema]

By the time I saw the patient, the infection had started. She saw me again early the next morning, had significant blood in the anterior chamber, and I referred her back to the ophthalmologist immediatly, although she was scheduled to see him later the same day. I felt hospital admission was indicated, but by then agressive antibiotic therapy was ineffective. I don't know if culture and sensitivity was done, or if any IV antibiotics were initiated, but next time I saw the patient, She was 24 hours post-op, and planning a visit to the ocularist. I have a limited knowlege of ocular TPAs, but even I know a corneal abrasion from an animal source requires both antibiotics and close observation.

Good call getting that patient out! Sounds like a possible pseudomonas aeruginosa.:( Free living on soil, on surfaces of animals and perforates the cornea in no time at all.

Couple of questions though; was this patient a CL wearer? How long was it between the abrasion and when you encountered her? You mentioned you were involved with a bandage CL, I take it that you applied the BCL the day before the hyphema showed up in the anterior chamber? How does fitting of a BCL fit into the scope of practice of a BC optician if in effect you are treating the corneal abrasion?

[npdr]

Spectacles, contact lenses, intraocular lenses, RK surgery, Lasic, anything to correct or evaluate vision.
Even determining acutity beyond light preception is more or less useless during the healing process.

With such a large abraded area, I don't believe that a CF or HM vision designation is being too casual. More important than the visual acuity is the resolution of the corneal epithelial break. I would probably not quivel with whomever took the acuity even if the designation was counting fingers (CF) in the injured eye.

[snowmonster]

Spectacles, contact lenses, intraocular lenses, RK surgery, Lasic, anything to correct or evaluate vision.
Even determining acutity beyond light preception is more or less useless during the healing process.

Try to tell that to the lawyers.

[chip anderson]

Shouldn't be a problem with the lawyers now that "a complete eye exam" doesn't include refraction."

[NC-OD]

Am I the only one that is totally baffeled that a supposed doctor of optometry is asking such an elementary question? This is learned in the 3rd year of optometry school if not earlier.

If a doctor has to ask this kind of question, I really don't think they should be treating this person. It's really embarassing for me to read this. Dude or dudette, there is gobs of vasoline-like ointment in the eye, of course it's gonna be blurry.
:drop:

[peregrinerose]

Am I the only one that is totally baffeled that a supposed doctor of optometry is asking such an elementary question? This is learned in the 3rd year of optometry school if not earlier.

If a doctor has to ask this kind of question, I really don't think they should be treating this person. It's really embarassing for me to read this. Dude or dudette, there is gobs of vasoline-like ointment in the eye, of course it's gonna be blurry.
:drop:

Haven't you noticed the range of answers on here regarding treatment? Every doc practices a little differently and manages a corneal abrasion differently, and probably all of them work fine. For a new doc to have a wicked *** abrasion and not 20/20 vision quickly, it can make the heart rate increase a little, make one a little nervous... did you graduate so long ago that you forgot your first really bad abrasion management and second guessing yourself? I don't see anything at all wrong with the question, with second guessing oneself and looking to more experienced collegues for backup. That's the mark of a good doc, it's the ones that muddle along without asking questions that scare me.

[npdr]

'....I don't see anything at all wrong with the question, with second guessing oneself and looking to more experienced collegues for backup. That's the mark of a good doc, it's the ones that muddle along without asking questions that scare me.

I agree.

I think he should not gauge the progress of the abrasion by the visual acuity, though.

[NC-OD]

Haven't you noticed the range of answers on here regarding treatment? Every doc practices a little differently and manages a corneal abrasion differently, and probably all of them work fine. For a new doc to have a wicked *** abrasion and not 20/20 vision quickly, it can make the heart rate increase a little, make one a little nervous... did you graduate so long ago that you forgot your first really bad abrasion management and second guessing yourself? I don't see anything at all wrong with the question, with second guessing oneself and looking to more experienced collegues for backup. That's the mark of a good doc, it's the ones that muddle along without asking questions that scare me.

So he goes to an optician website to ask a question???

It sounds as if this doc did not get proper training. I had seen 20+ such cases (externships) before I ever got out of school and felt very comfortable. Nothing wrong with asking questions for confirmation. I just question whether this was the proper forum.

[peregrinerose]

So he goes to an optician website to ask a question???

It sounds as if this doc did not get proper training. I had seen 20+ such cases before I ever got out of school and felt very comfortable.

And so because you were 100% comfortable from day 1 everyone should be, and if they are not, they are incompetant? Wow.

[Fezz]

So he goes to an optician website to ask a question???

Dear Doctor,

I beg to differ. If you look a little closer-Optiboard is:

"The Premier Online Community for Eyecare Professionals"

I think that includes Optometrists.....don't you?

[NC-OD]

Dear Doctor,

I beg to differ. If you look a little closer-Optiboard is:

"The Premier Online Community for Eyecare Professionals"

I think that includes Optometrists.....don't you?

Sure........but we know how ODs are treated here. It's an optician site and there nothing wrong with that. ODs and OMDs have their own sites too.