Concluded Case

30/m while traveling in bus ( window seat ) roadside tree branches hit over him and small stick prick over his left eye penetrated into cornea. complaints of irritation, and severe pain. wht s the mgmnt?

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Fungal keratitis , traumatic cataract following penetrating injury to cornea by vegetative material : Rx *Pt must be treated by an ophthalmologist. * Rx must be started immediately. * cauterisation of ulcer. * natamycin ,fluconazole ,moxifloxacin chloramphenicol with polymyxin e/drops 1 hrly. * atropine e/drops tid. * Timolol e/drops if anterior chamber is sealed & formed. * dark glasses. * tab. Nsaid ,tab.fluconazole,tab. Cefixime . * Daily followups till infection comes under control. * traumatic cataract is to be dealt with later on after keratitis is completely healed. It will take some weeks for complete cure to occur

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Wodden foreign body infecting lacerated cornea leading to fungal infection look for any leakage with sidel test using flourescin debride the area if possible make slide mount with koh look for fungal hyphae and sample for c/s Start wiith fluconazole e/d 6 hourly , moxflox e/d Homide e/d systemic tab fluconazole 150mg od tab cifran 500bd ibubrufen 8 hourly Adjust treatment after c/s finding

Valuable opinion
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The corneal laceration and gross lid oedema ; after taking swab and culture start treatment with 4 hrly instillation of topical antibiotic and 1% atropine drops If culture report reveals fungal infection then only antifungal topical drops are used. Also use of oral antibiotic/or antifungal as the case may be must be used. If possible hospitalization in this case appears to be wise !

I agree
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Urgently reffer him to ophthalmologist. D/d corneal laceration Hyphema Subluxation of lens. Wt about vision?

Foreign body removed by ophthalmologist Vision is normal.. corneal laceration is thr. Vision s normal
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Fungal keratitis , traumatic cataract following penetrating injury to cornea by vegetative material : Rx *Pt must be treated by an ophthalmologist. * Rx must be started immediately. * cauterisation of ulcer. * natamycin ,fluconazole ,moxifloxacin chloramphenicol with polymyxin e/drops 1 hrly. * atropine e/drops tid. * Timolol e/drops if anterior chamber is sealed & formed. * dark glasses. * tab. Nsaid ,tab.fluconazole,tab. Cefixime . * Daily followups till infection comes under control. * traumatic cataract is to be dealt with later on after keratitis is completely healed. It will take some weeks for complete cure to occur

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Corneal injury resulting laceration Pupil should dilated with homatropine eye drops or put atropine eye oint at bed time rest moxifloxacin eye drops twice daily and oint at bed time Antiinflamatory eye drops Follow the opthamologist opinion He should be given eye pad bandage or black goggles

Traumatic corneal lacerated injury by wooden stick along with oedema lids Swab from cornea for CS Atropine 1% every 4 hours, Moxifloxacin every hour Oral Antibiotics/Anti inflammatory/Analgesic Early hospitalization & keep under care of Ophthalmologist

Corneal laceration Hyphema Subluxation of lens

Thank you doctor
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Anterior chamber of eye to be visualized. Prophlactic cover of antibiotics and antifungals for the keratoconjunctivitis. No steroids Atropine eye drops if too much spasm.

1. Removal of the foreign body immediately, suturing of the wound to be done. 2. If any broken piece of twig is retained in anterior chamber, it has to be removed carefully without causing any damage to iris and lens. 3. Post operative topical higher antibiotics and cycloplegics, antifungal agents to be started( as there is risk of development of fungal keratitis). Also broad spectrum antibiotics systemically. 4. Carefully patient has to be followed for keratitis, endophthalmitis or anterior chamber involvement by fungal infection. If so, intracameral antifungal to be given.

Also have to deal with the traumatic cataract later
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