Case history
Case history #1
A 32-year-old man is struck in the face with a branch while hiking through dense bush. He is not wearing any eye protection and feels immediate pain, discomfort, and watering on opening his right eye. He does not wear contact lenses. He has photophobia in the right eye, and there is marked conjunctival injection but normal visual acuity. After instillation of a topical anesthetic his symptoms resolve, facilitating a complete slit lamp exam, which reveals a 3 mm corneal defect with fluorescein uptake without ulceration or any foreign body.
Case history #2
A 22-year-old woman presents to the emergency department with acute bilateral eye pain after removing her contact lenses 1 hour ago. She reports forgetting to remove her daily wear lenses at bedtime and awakening in the morning with bilateral mild eye pain. On removal of both lenses she reports markedly increased pain, photophobia, and foreign body sensation. With glasses, her visual acuity is 20/30 bilaterally. On slit lamp exam, she has no ulceration but diffuse fluorescein uptake in a contact lens distribution bilaterally.
Other presentations
The clinical presentation usually involves a foreign body sensation, photophobia, and tearing. A lack of obvious historic clues in children can make the diagnosis more challenging if they cannot recall or vocalize preceding trauma. Defects may also occur spontaneously in those who have either epithelial damage from a previous abrasion or dystrophic basement membranes. These patients tend to experience pain at night or when first opening their eyes in the morning.
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