Assignment task:
1-For the pharmacologic management of AM, who presents a corneal abrasion associated with contact lens wear, we recommend the immediate suspension of the lenses and the instauration of a broad spectrum antibiotic eye drop with activity against Pseudomonas, preferably a fourth generation fluoroquinolone (for example, moxifloxacin or gatifloxacin) in an initial schedule of instillation every 2-4 hours during the first 24-48 hours and then four times a day until complete epithelial healing. Intensive lubrication with artificial tears is associated to favor re-epithelialization and a cycloplegic eye drop (homatropine 1%) can be added once a day to alleviate pain due to ciliary spasm. Anesthetics should not be prescribed because of the risk of delayed healing and corneal complications (Cassano et al., 2021).
2-AM should be re-evaluated within 24 to 48 hours to check for complete healing of the corneal epithelium and to rule out the appearance of infiltrates or signs of infection; at this visit, visual acuity should be assessed, fluorescein staining should be repeated and if possible, slit-lamp examination should be performed to confirm closure of the epithelial defect and the absence of edema or stromal inflammation. During follow-up it is essential to reinforce the total suspension of contact lenses until complete recovery, to insist on the correct instillation of antibiotic and lubricants, and to monitor the appearance of alarm symptoms, increased pain, hypopyon, purulent discharge or worsening of vision that would require urgent referral to an ophthalmologist. Once the erosion has closed without complications, adaptation to new contact lenses can be started gradually under specialized supervision (Kobia-Acquah et al., 2021).
3-AM should be advised to immediately discontinue contact lens wear until complete healing of the corneal epithelium to avoid the introduction of microorganisms and prevent the development of Pseudomonas keratitis or other pathogens. Once the ophthalmologist confirms corneal repair, AM should debut a new pair of monthly lenses, strictly adhere to the replacement schedule, employ proper cleaning and disinfection techniques, and avoid swimming, showering or sleeping with the lenses to minimize the risk of reinfection and new abrasions (Flanagan et al., 2020). Need Assignment Help?
References:
Cassano, F., Cardascia, N., Tegola, M. G. L., Boscia, F., & Alessio, G. (2021). Scedosporium apiospermum contact lens-related keratitis: A case report and literature review. Medical Hypothesis, Discovery & Innovation Ophthalmology Journal, 10(2), 80-85.
Flanagan, G., Velez, T., Gu, W., & Singman, E. (2020). Contact Lens Wear, Corneal Complications, and U.S. Service Member Readiness. Military Medicine, 185(11-12), e2071-e2075.
Kobia-Acquah, E., Akowuah, P. K., Antwi-Adjei, E. K., Forkuo, P. M., Koomson, N. Y., Odotei, S. O., Alabi, E., & Donkor, R. (2021). Contact lens complications among wearers in Ghana. Contact Lens & Anterior Eye: The Journal of the British Contact Lens Association, 44(1), 67-71.