Corneal Injuries

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Question 1 of 10

1. Question
When considering the management of patients with eye injuries presenting to the emergency department (ED), which one of the following statements is true?
- Most eye injuries occur in the home
- Elderly males are the most likely group of patients to suffer an eye injury
- Eye injuries complicate approximately 2% of all major trauma
- Eye injuries are always easily identified in a patient with major trauma
- Eye injuries account for 10% of all ophthalmological attendances to the ED
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Question 2 of 10

2. Question
When considering the anatomy and pathophysiology of corneal injuries, only one of the following statements is correct – which one is it?
- Ultraviolet injury to the eye can cause an inflammatory response leading to superficial keratitis
- The cornea is composed of four distinct layers
- The stroma contains large numbers of nerve endings which accounts for its sensitivity to touch
- Chemical injuries with acids have a worse prognosis than alkalis as they cause more damage by faster penetration of the cornea
- The reduction in visual acuity found in corneal abrasion is mainly due to oedema developing in the endothelium
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Question 3 of 10

3. Question
A 28-year-old woman patient presents to the ED with a painful left eye. She thinks that something has blown into the eye whilst she was walking along. Which one of the following statements is correct regarding your assessment of this patient?
- It is not necessary to measure the visual acuity in this patient as she says her vision "seems OK"
- A corneal abrasion will appear blue after instillation of fluorescein into the eye
- If no foreign body can be seen, an x-ray is always needed to exclude an intraocular foreign body
- The eyelid must be everted to look for a subtarsal foreign body
- Local anaesthetic should be instilled to ease pain and aid examination. Tetracaine is the agent of choice
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Question 4 of 10

4. Question
With regard to the management of corneal abrasions, which one of the following statements is true?
- The affected eye should be protected with an eye pad
- Proxymetacaine is the least painful local anaesthetic agent when instilled into the eye
- Mydriatics should be used routinely to reduce pain in corneal abrasion
- Routine tetanus prophylaxis is recommended in cases of corneal abrasion
- The use of steroid eye drops has been shown to speed up the healing of a corneal abrasion
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Question 5 of 10

5. Question
A 36-year-old man presents to the ED following an accident whilst gardening. He was pruning a shrub, when a twig hit him in the right eye. Following a thorough assessment, you diagnose a small corneal abrasion. He is complaining of considerable pain in the eye. Only one of the following statements is correct regarding providing analgesia for this patient – which one is it?
- The use of an eye pad may increase the pain
- Non-steroidal anti-inflammatory eye drops (NSAIDs) are more effective than oral preparations for analgesia
- It is a good idea to provide him with some local anaesthetic eye drops to use until the abrasion heals
- Diclofenac eye drops are not licensed for use for analgesia in corneal abrasion
- There is good evidence that topical NSAIDs are highly effective in reducing the pain from a corneal abrasion
Correct

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Question 6 of 10

6. Question
Which one of the following statements is true regarding the use of topical antibiotics in corneal abrasion?
- Eye ointment has been shown to be superior to eye drops in the prevention of infection
- Contact lens wearers are at increased risk from Klebsiella infection
- The wearing of contact lenses can be resumed after 24 hours
- 10% chloramphenicol eye ointment is commonly used
- Fusidic acid eye drops are no more effective than chloramphenicol eye ointment
Correct

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Question 7 of 10

7. Question
Which one of the following statements regarding follow-up for patients with a corneal abrasion is true?
- There are no nationally agreed guidelines regarding follow-up arrangements for corneal abrasion
- Patients should not be referred to GPs or ENPs for follow-up of their corneal abrasion
- Follow-up, with examination using fluorescein stain, is advised after four days
- Failure of a corneal abrasion to heal within 24 hours should prompt a referral to an ophthalmologist
- At follow-up, increased pain is not a reason to refer a patient to an ophthalmologist
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Question 8 of 10

8. Question
Which one of the following statements regarding corneal foreign bodies and rust rings is correct?
- Removal of an embedded corneal foreign body with a needle is best done without magnification
- Iron, in its oxidised form, is insoluble in corneal tissue
- Rust rings are best removed immediately on presentation as they become more adherent to the cornea with time
- Rust ring removal has been shown to take up to twice as long with a needle as with an ophthalmic burr
- A rust ring is formed by oxidised copper and cellular infiltrate
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Question 9 of 10

9. Question
When considering chemical splashes and burns to the eye, which one of the following statements is correct?
- Chemical burns represent 25% of all eye injuries presenting to the ED
- Referral to an ophthalmologist is appropriate when there is fluorescein uptake following adequate eye irrigation
- Eye irrigation following chemical splashes should be performed for 20-30 minutes
- Eyes should be irrigated copiously following exposure to CS spray
- Randomised control trials have shown that normal saline is better than water for irrigation of the eyes following chemical burns
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Question 10 of 10

10. Question
A 55-year-old mechanic has been welding but neglected to use his welding mask. He presents to the ED with bilaterally painful watering eyes. Which one of the following statements is correct regarding this patient’s problem?
- Pathophysiologically this problem is the same as that caused by sun lamps and laser pointers
- Examination of the patient's eyes can be avoided as the diagnosis is clear from the history
- Topical antibiotics should be prescribed
- The patient should be informed that it will take at least one week for the pain and watering to resolve
- Mydriatics are of no help in this problem
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Corneal Injuries – Post Test

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