A 34-year-old man presents to urgent care with a complaint of redness and mild irritation in his right eye for the past 3 days. He reports that “it feels like something is in my eye.” He denies itching, opaque discharge, or vision changes, but says he has had mild photophobia. He wears contact lenses most days. After performing the physical exam, a slit lamp exam, and fluorescein staining, you diagnose a small corneal abrasion in the right eye. Which of the following treatment plans would be most appropriate for this patient?
a. Prescribe topical fluoroquinolone drops and advise him to abstain from contact lens wear until the abrasion has been confirmed to have resolved at follow-up.
b. Prescribe topical fluoroquinolone drops and advise him to abstain from contact lens wear until the abrasion has been confirmed to have resolved at follow-up; apply an eye patch to protect the eye during healing.
c. Advise him to use lubricating drops and abstain from contact lens wear until the abrasion has been confirmed to have resolved at follow-up.
d. Advise him to use lubricating drops and abstain from contact lens wear until the abrasion has been confirmed to have resolved at follow-up; apply an eye patch to protect the eye during healing.
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Answer: A. Although corneal abrasions are likely to resolve rapidly with conservative eye protection, including lubrication and avoidance or removal of the offending trigger, patients who wear contact lenses should be treated with topical fluoroquinolone due to the increased risk of keratitis. Eye patches are no longer commonly used in the treatment of simple corneal abrasions and should never be used to treat a patient who wears contact lenses, as patching increases the risk of bacterial infection.
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