CORNEAL ULCER

1. AUTHOR Maerov-P-H
TITLE Ocular emergencies
SOURCEMedicine North America 1989 May; 33:6004-13
  
2. AUTHORArnold-R-W, Crouch-E-E.
TITLE An emergency corneal ulcer kit.
INSTITUTION Ophthalmic Associates, Anchorage, Alaska 99501.
SOURCEAlaska-Med 1991 Oct-Dec, VOL: 33 (4), P: 151-3, ISSN: 0002-4538.
ABSTRACT Bacterial corneal ulcer is a potentially blinding emergency which
should ideally be treated by an ophthalmologist aided by slit lamp biomicroscopy, microbial stain and cultures, and then selected fortified topical antibiotics. We suggest an emergency corneal ulcer kit for the initial treatment of patients with suspected corneal ulcers who are unable to readily travel to an
ophthalmologist. Author.
3. AUTHOR McDonnell-P-J, Nobe-J, Gauderman-W-J, Lee-P, Aiello-A,
Trousdale-M.
TITLE Community care of corneal ulcers (see comments).
INSTITUTION Doheny Eye Institute, Los Angeles, CA 90033.
SOURCE Am-J-Ophthalmol 1992 Nov 15, VOL: 114 (5), P: 531-8, ISSN:
0002-9394. CM
Comment in: Am-J-Ophthalmol 1992 Nov 15; 114(5):630-2; Comment in: Am-J-Ophthalmol 1993 Mar 15; 115(3):402-3.
ABSTRACT Because of increasing concern about the appropriate and cost- effective use of eye care services and procedures, several organizations have sought to arrive at practice guidelines or practice patterns from which physicians can draw guidance. To assess the potential effectiveness of such guidelines, we reviewed the care of patients with corneal ulcers. Corneal specialists recommend that cultures be obtained before initiation of treatment. We determined whether ophthalmologists implemented these guidelines by the following:
(1) a review of records of 79 patients referred to a tertiary care corneal and external disease service for evaluation of keratitis, and (2) a survey by mail of practicing ophthalmologists. Antibiotic therapy without any cultures was observed in 38 of 79 referred patients with corneal ulcers (48.1%). Our survey of general ophthalmologists disclosed that 274 of 560 patients with corneal ulcers (48.7%) were treated with antibiotics without any cultures being obtained. Compliance with recommended practice in the care of corneal ulcers is poor, as measured with either method. This procedure provides insights into more effective implementation of future practice guidelines. Author.
4. AUTHORMcLeod-S-D, DeBacker-C-M, Viana-M-A.
TITLEDifferential care of corneal ulcers in the community based on apparent severity.
INSTITUTIONIllinois Eye and Ear Infirmary, University of Illinois at Chicago, 60612,
USA.
SOURCE Ophthalmology 1996 Mar, VOL: 103 (3), P: 479-84, ISSN: 0161-6420.
ABSTRACT:
PURPOSE: To describe current practice patterns in treating infectious
keratitis.
METHODS:A questionnaire was designed that asked ophthalmologists to describe the diagnostic equipment accessible to their practice for performing smears and obtaining scrapings for microbial culture and sensitivity testing. The questionnaire also presented two hypothetical cases of patients with infectious keratitis. Bacterial keratitis was relatively early and less severe in the first patient, and it was more advanced and more severe in the second patient. Recipients were asked about their diagnostic and therapeutic approach. The survey was mailed to 300 ophthalmologists in Florida, Illinois, and New York.
RESULTS: One hundred twenty-four completed surveys (45%) were returned. Six surveys were from cornea specialists, who were excluded from the analysis. Only 18 practices (15%) maintained access to Gram stain supplies, and 58 (50%) maintained culture supplies. Whereas 56% of respondents would treat the patient with the less severe bacterial keratitis without obtaining samples for cultures, only 13% would treat the patient with the more severe condition in this manner (P<0.00001). Of the respondents, 82% would treat the patient with the less severe bacterial keratitis with a fluoroquinolone, compared with 62% for the patient with the more severe infection (P=0.002). The mean frequency of fluoroquinolone administration for the patient with more-severe bacterial keratitis was one drop every 0.88 hours, compared with one drop every 1.48hours for the patient with the less severe infection.
CONCLUSIONS:Ophthalmologists appear to treat suspected infectious keratitis differently, depending on perceived severity; they choose different antibiotic regimens; and are more likely to forgo scrapings for Gram staining and cultures for ulcers that appear less severe. The justification for this approach should be established. Author.

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