Online Photo Diagnosis

By William Townsend, OD, FAAO

The linear lesion seen in this patient resulted from a very hot steel fragment passing across the surface of the cornea. In effect, the epithelium was totally destroyed in the affected areas. Crucial prognostic indicators included charring of the tissue, penetration of the burn into Bowman's layer and stroma, and loss of large areas of corneal epithelium.

To treat this patient, we first anesthetized the cornea with topical proparacaine 0.5% solution. We then debrided the areas of burned epithelium using a sterile Kimura spatula. Vigamox (Moxifloxacin [as HCl] 0.5%, Alcon) was instilled into the cul de sac, and we placed an 8.6mm base curve Night & Day lens on the eye as a bandage lens. The patient was instructed to instill Vigamox every 6 hours. We selected Vigamox for this patient because it is not preserved with a toxic substance such as BAK and it has a very broad spectrum of activity. Following treatment, the patient retained 20/20 vision and was able to resume all activities.