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Dear Dr. Doan and List,
A 67 year old HF presents from the Emergency room with a 7 day history of red and painful left eye. She is a resident of a "senior home" and had been bedridden 1 week before with a mild URI . She is photobphic with no discharge. No history of trauma and she is not a contact lens wearer.
Physical examination shows that PH vision is OD 20/25 and OS HM 5 feet. There is a 4mm central corneal "ulcer" that is centrally excavated and traps fluoroscein. The anterior chamber shows 4+ flare without cells. The right eye is quiet but shows mutliple superficial corneal opacities (CFB? ulcers?).
The corneal sensitivity is normal for both eys.
Culture shows coagulase negative and shows resistance to ciprofloxacin and its relatives.
A 3 day course of Zymar q3 hrs did not improve the situation. It actually increased in size by 2x.
Questions:
1. At what point would you consider fortified antibiotics?
2. If so, which?
3. Would you start wtih Tobramycin 9mg/ml? or not?
4. When would you consider a corneal biopsy?
Thanks,
RIchard_Hom
A 67 year old HF presents from the Emergency room with a 7 day history of red and painful left eye. She is a resident of a "senior home" and had been bedridden 1 week before with a mild URI . She is photobphic with no discharge. No history of trauma and she is not a contact lens wearer.
Physical examination shows that PH vision is OD 20/25 and OS HM 5 feet. There is a 4mm central corneal "ulcer" that is centrally excavated and traps fluoroscein. The anterior chamber shows 4+ flare without cells. The right eye is quiet but shows mutliple superficial corneal opacities (CFB? ulcers?).
The corneal sensitivity is normal for both eys.
Culture shows coagulase negative and shows resistance to ciprofloxacin and its relatives.
A 3 day course of Zymar q3 hrs did not improve the situation. It actually increased in size by 2x.
Questions:
1. At what point would you consider fortified antibiotics?
2. If so, which?
3. Would you start wtih Tobramycin 9mg/ml? or not?
4. When would you consider a corneal biopsy?
Thanks,
RIchard_Hom