General Data E. V. 15/M Single Sampaloc, Manila Roman Catholic

Chief Complaint Eye Injury

History of Present Illness 2 days PTA 1 Day PTA (+) accidentally injured his L eye while playing with younger sibling. No consult, no medications given (+) periorbital swelling and eye redness. (+) discharge and blurring of vision CONSULT

Review of Systems (+) low grade fever (-) headache (-)chest, abdominal pain (-) cough, colds (-) dysuria, (-) diarrhea

Past Medical History (+) dengue fever 2007 (-) HPN, DM, BA, allergies

Family History (+) Bronchial Asthma (-)HPN, DM, allergies, CA

Personal and Social History (+) 1 pack year smoking history (+) occassional alcoholic drinker Denies illicit drug High School Drop-out, currently unemployed

Pediatric History Born to a then 27y/o G2P1 via SVD at home by a hilot Immunization: allegedly complete via a local health center

Physical Examination Awake, coherent, not in distress BP: 110/80 HR: 76 RR: 18 Temp: 37C (-)Cervical lymphadenopathies, neck vein engorgement, anterior neck masses Equal chest expansion, clear breath sounds Adynamic precordium, distinct heart sounds, normal rate regular rhythm, (-)murmurs Abdomen flat, normoactive bowel sounds, soft, non-tender Full and equal pulses, (-)edema, cyanosis

Physical Examination VA : OD 20/20 OS No light Perception Gross: EOM: Tonometry: OD softOS: firm Funduscopy: OD (+) ROR, CM, AVR 2:3, DDB 0.3, (-)h/e OS (-) ROR (+) erythema (+) swelling 2-3mm BRTL OD

Assessment: Corneal Perforating Injury with Panophthalmitis, OS

Background Offers protection, refraction and filtration of UVL 5 layers – Anterior epithelium – Bowman’s layers – Corneal stroma – Descemet’s layer – Endothelium

Corneal Perforating Injury Can manifest as – Distorted pupil – leaking aqueous humor – low intraocular pressure Slit lamp examination – Perform fluorescein instillation and examination with blue light – Visualize any abrasion and leaking aqueous humour (Seidel sign)

Corneal Perforating Injury Management – Tetanus Immunization – Pain medications (NSAIDS) – Antibiotics Erythromycin or Tobramycin

Panophthalmitis Inflammation of all the coats of the eye including intraocular structures Endogenous – Caused by hematogenous spread of organisms from another infection Exogenous – Direct inoculation of bacteria to the eye – Staphylococcal, streptococcal, and Bacillus species are the common infective agents

Panophthalmitis Systemic and topical antibiotics Tetanus immunization Pars plana vitrectomy should be considered