Treatment
Initial Treatment
When our patient first presented approximately 18 hours post injury, he was diagnosed with a penetrating knife injury to the left eye resulting in prolapse of the iris, ciliary body and retinal tissue. The eye was immediately surgically repaired, and an intraocular foreign body removal was performed. The patient was treated with antibiotics and steroid therapy.
- Topical steroids- 1% prednisolone acetate every 2 hours
- Periocular steroids – subconjunctival dexamethasone injections 3 times per week
- Systemic steroids
- Antibiotics
After discharge the patient was non-compliant and stopped therapy. Three weeks later the patient presented with bilateral panuveitis.
At this point the ophthalmologists enucleated the injured eye as it was blind and causing a sympathetic reaction in the uninjured eye.
The patient was then started on oral prednisone.
The most important aim in treating eye wounds is to maintain and improve visual outcome. This requires prompt initial treatment and aggressive doses of anti-inflammatory drugs to control the immune responses described in this discussion. High doses of oral prednisone are typically used which are then tapered according to therapeutic response. When necessary, especially if longer-term treatment is needed, other immunosuppressive medications, such as cyclosporine, infliximab and methotrexate can be used to control inflammation.
