A 28-year-old patient presents to the emergency department with eye pain, tearing, and photophobia after soil blew into the right eye while gardening. Slit-lamp examination reveals a linear corneal epithelial defect that stains with fluorescein. What is the most appropriate initial intervention?
Instilling a topical ophthalmic anesthetic (e.g., proparacaine) is the best first step. Immediate anesthesia relieves pain, stops blepharospasm, and allows a thorough fluorescein and slit-lamp inspection for retained foreign bodies or additional injury. These agents are strictly for in-department evaluation; repeated home use is avoided because they can delay corneal healing and cause toxic keratopathy.
After anesthesia and examination, the eye can be gently irrigated to remove any loose debris, and a topical antibiotic is applied for prophylaxis. Routine pressure patching is no longer recommended because studies show it does not speed healing and may increase infection risk.
Why the other choices are not first:
Irrigation with saline is useful but is best performed once pain control permits the patient to keep the eye open.
Prophylactic antibiotic ointment is important but follows the initial exam.
Patching offers no benefit and can hinder recovery.
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Maxillofacial and Ocular Emergencies
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