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SAEM Clinical Images Series: Contact Your Nearest Ophthalmologist

Posted by Andrew Helber, MD on

A 29-year-old female with a past medical history of migraine headaches presented to the emergency department (ED) for several hours of bilateral eye pain, redness, and decreased visual acuity. The patient is a contact lens wearer. The night prior to presentation at 18:00, the patient inserted her contacts that she had washed and soaked in a hydrogen peroxide (H2O2) cleaning solution. She removed the contacts five hours later at 23:00, at which time she noted her eyes to feel drier than normal but did not note significant pain with removal, significant trauma, or a partial contact removal. For the eye dryness and mild irritation, she rinsed her eyes with her contact solution. She woke up the following day at 6:00 with severe, bilateral eye pain, blurry vision, and difficulty opening her eyes due to pain. She again washed her eyes with contact solution which resulted in worsening pain while also noting a “fizzing” sensation in her eyes which prompted her presentation to the ED at 10:00. She denied any foreign body sensation, known trauma, or experiencing similar symptoms previously.

Physical Exam

General: Mildly uncomfortable appearing

Eyes: Bilateral corneal injection with mild tearing. No foreign body on lid eversion. Uncorrected visual acuity of 20/200 in the right eye and 20/30 in the left eye. Extra-ocular movements intact. Right eye pressure measured 18 mmHg and left eye 17 mmHg. pH 7.0 in both eyes.

Laboratory Data

None

Case Question: What is the significance of the green (Fluorescein) uptake in both eyes?

Fluorescein uptake represents defects in the cornea that allow for this dye to pool. For this case, this represents trauma caused by contact lens removal as the uptake covers the areas where contacts are placed.

Given the location and size of these defects, antibiotic drops should be promptly initiated, and prompt ophthalmologic evaluation should be obtained.

Case Discussion

Take-Home Points

  • Corneal abrasions can occur in both eyes at once.
  • Timely administration of antibiotic drops and ophthalmology evaluation is crucial to prevent progression to corneal ulcer and the need for corneal transplant.

References

  • Cope JR, Collier SA, Rao MM, Chalmers R, Mitchell GL, Richdale K, Wagner H, Kinoshita BT, Lam DY, Sorbara L, Zimmerman A, Yoder JS, Beach MJ. Contact Lens Wearer Demographics and Risk Behaviors for Contact Lens-Related Eye Infections–United States, 2014. MMWR Morb Mortal Wkly Rep. 2015 Aug 21;64(32):865-70. doi: 10.15585/mmwr.mm6432a2. PMID: 26292204; PMCID: PMC5779588.
  • Stapleton F, Bakkar M, Carnt N, Chalmers R, Vijay AK, Marasini S, Ng A, Tan J, Wagner H, Woods C, Wolffsohn JS. CLEAR – Contact lens complications. Cont Lens Anterior Eye. 2021 Apr;44(2):330-367. doi: 10.1016/j.clae.2021.02.010. Epub 2021 Mar 25. PMID: 33775382.
  • U.S. Food and Drug Administration. (2022, August 16). Hydrogen Peroxide Solution. Hydrogen Peroxide Solution | FDA. Retrieved September 5, 2022, from https://www.fda.gov/medical-devices/contact-lenses/hydrogen-peroxide-solution

Copyright

Images and cases from the Society of Academic Emergency Medicine (SAEM) Clinical Images Exhibit at the 2023 SAEM Annual Meeting | Copyrighted by SAEM 2023 – all rights reserved. View other cases from this Clinical Image Series on ALiEM .

Author information

Andrew Helber, MD

Resident Physician
Department of Emergency Medicine
University of Pennsylvania

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The post SAEM Clinical Images Series: Contact Your Nearest Ophthalmologist appeared first on ALiEM.

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