How are vision threatening corneal ulcers and ulcerative keratitis treated?

Updated: Nov 08, 2018
  • Author: Jesse Borke, MD, FACEP, FAAEM; Chief Editor: Barry E Brenner, MD, PhD, FACEP  more...
  • Print
Answer

Large (>1.5 mm) and/or central infiltrate, deep anterior chamber inflammation, and/or any scleral involvement

Consult with ophthalmologist immediately, and consider emergent ophthalmology consult in the ED; transfer may be appropriate in order to effect this evaluation.

Two fortified eyedrops every 5 minutes in the ED for 5 doses, tobramycin 15 mg/mL every 1 hour, alternating every 30 minutes with fortified vancomycin 25-50 mg/mL every 1 hour (alternative, cefazolin 50 mg/mL every 1 hour in place of vancomycin) [9]

Consider adding oral or intravenous ciprofloxacin

Cycloplegics

Cycloplegic drops (atropine 1% or cyclopentolate 1% [most common agent]) are applied to provide comfort and to prevent synechiae formation (adhesions between the iris and the lens capsule or cornea, posterior or anterior).


Did this answer your question?
Additional feedback? (Optional)
Thank you for your feedback!