TREATMENT—Moderate  and  severe  con- tusions should be referred to an ophthalmologist. Any injury causing hyphema involves the danger of  secondary  hemorrhage  that  may  result  in irreversible   glaucoma.   Patients   with   hyphema should be placed on bed rest for 6 to 7 days with both  eyes  bandaged. Lacerations Lacerations involving the lid margins should be  referred  to  an  ophthalmologist.  Lacerations involving  the  conjunctival  need  not  be  sutured. Instill antibiotics to prevent infection. Corneal or scleral  lacerations  should  be  lightly  bandaged  and covered with a metal shield. Instruct the patient to  avoid  squeezing  his  or  her  eyes  together  and to  remain  quiet.  Pressure  exerted  may  result  in extrusion  of  the  intraocular  contents.  In  all lacerations involving the eye, transfer the patient to  an  ophthalmologist. Conjunctivitis This  is  an  inflammation  of  the  thin  mucous membrane lining the inner portions of the eyelids and   anterior   surface   of   the   eyeballs.   The inflammation  may  be  acute  or  chronic  and  can be due to chemical irritation, allergy, bacterial or viral infection, and fungal or parasitic infection. .  Bacterial  Conjunctivitis—It  produces  a purulent  discharge,  photophobia,  and  reddening of the eyelids and conjunctival. The eyelids may burn,  itch,  or  hurt,  and  often  there  is  marked edema.   The   discharge   repeatedly   turns mucopurulent and may seal the eyelids at night. The  condition  usually  lasts  about  10  days. TREATMENT—There   is   no   specific   treat- ment, but sulfonamide therapy helps to prevent secondary   infection. .  Viral  Conjunctivitis—Blennorrhea  is  also called  inclusion  conjunctivitis.  It  is  a  venereal infection  resulting  from  nongonorrheal  cervicitis and  urethritis  that  can  be  spread  to  the  eyes during and after intercourse. In the past this form was  also  spread  during  swimming  and  was  known as  swimming  pool  conjunctivitis.  Adequate chlorination  of  swimming  pools  has  eliminated this  mode  of  transportation. SYMPTOMS—There   is   usually   a   copious watery discharge with scanty exudate, occasional fever,  and  malaise  as  well  as  lacrimation, photophobia,  sensations  of  sand  or  grit  in  the  eye, and  burning  in  the  eyelid  margins. TREATMENT—Isolation techniques, such as separate  towels, are   advisable.   Treat   with sulfonamides  or  tetracycline  systemically  for 3  weeks.  Instill  tetracycline  drops  in  oil  to supplement the systemic tetracycline. l  Allergic  Conjunctivitis—This  is  commonly and  most  frequently  associated  with  hay  fever. SYMPTOMS—There   is   usually   tearing, itching,  redness,  and  a  thin  stringy  discharge. TREATMENT—Corticosteroid    therapy    is usually  effective. Hordeolum A  sty  is  a  common  abscess  formation  at  the eyelid  margin  due  to  staphylococcus. SYMPTOMS—There is usually pain, redness, swelling, and an area of tenderness on the upper or lower eyelid. The intensity of the pain is related to the amount of swelling. The abscess tends to localize  within  a  few  days.  The  patient  sometimes complains   of   photophobia,   lacrimation,   and   a feeling  of  fullness  or  “foreign  body”  sensation. TREATMENT—Apply    warm    compresses. When  the  abscess  focuses  to  a  point,  it  will normally rupture spontaneously. An I&D may be performed if necessary. Irrigate the eye with warm saline  and  apply  local  antibiotics  or  sulfonamides. Dendritic Ulcer This a a superficial corneal ulcer caused by the herpes simplex virus. It is almost always unilateral and may affect any age group. It is characterized by  superficial  branching  gray  lesions  of  the cornea,  resembling  the  veins  in  a  leaf. TREATMENT—Transfer  the  patient  to  an ophthalmologist as soon as possible for removal of  the  ulcers. Iritis This  is  an  acute  inflammation  of  the  iris. When  the  ciliary  body  is  involved,  as  it  usually is,  the  condition  is  known  as  iridocyclitis. 2-22