Eye - California Department of Industrial Relations

Eye Disorders

Effective Date: April 1, 2017

Contributors

Editor-in-Chief:

Kurt T. Hegmann, MD, MPH, FACOEM, FACP

Evidence-based Practice Eye Panel Chair:

Bernard R. Blais, MD, FAAO, FACOEM, FACS

Evidence-based Practice Eye Panel Members:

Panel members represent expertise in ophthalmology, optometry, occupational medicine, medical

toxicology (preventive medicine), and law. Identities are blinded for external peer-review.

Methodology Committee Consultant:

Kurt T. Hegmann, MD, MPH, FACOEM, FACP

Research Conducted By:

Kurt T. Hegmann, MD, MPH, FACOEM, FACP

Jeremy J. Biggs, MD MSPH

Kristine Hegmann, MSPH, CIC

Matthew A. Hughes, MD, MPH

Matthew S. Thiese, PhD, MSPH

Ulrike Ott, PhD, MSPH

Atim C. Effiong, MPH

Brenden Ronna

Leslie Cepeda Echeverria

Dillon Fix

Austen James Knudson

Jeremiah Lafayette Dortch

Zachary Cooper Arnold

Alzina Koric

Ninoska De Jesus

Katherine Anne Schwei

Louise Juliet

Specialty Society and Society Representative Listing:

ACOEM acknowledges the following organizations and their representatives who served as reviewers of the

¡°Eye Disorders Guideline.¡± Their contributions are greatly appreciated. By listing the following individuals or

organizations, it does not infer that these individuals or organizations support or endorse the eye treatment

guidelines developed by ACOEM. An additional organization wished to remain anonymous.

American Association of Occupational Health Nurses

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Kim Olszewski, DNP, CRNP, COHN-S/CM, FAAOHN

American College of Emergency Physicians

Charles J. Gerardo, MD, MHS

Richard D. Shih, MD

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Table of Contents

Summary of Recommendations......................................................................................................................... 5

Overview ............................................................................................................................................................ 8

Definitions ........................................................................................................................................................................ 9

Impact .............................................................................................................................................................................. 9

Risk and Causation ......................................................................................................................................................... 10

General Approach and Basic Principles............................................................................................................ 12

Initial Care ........................................................................................................................................................ 15

Initial Assessment ............................................................................................................................................ 15

Presenting Symptoms .................................................................................................................................................... 15

History ............................................................................................................................................................................ 15

Red Flags ........................................................................................................................................................................ 17

Examination ................................................................................................................................................................... 18

Diagnostic Approach ........................................................................................................................................ 21

Special Studies and Diagnostic and Treatment Considerations ..................................................................................... 21

Diagnostic Criteria .......................................................................................................................................................... 22

Management Approach ................................................................................................................................... 24

Follow-up Visits .............................................................................................................................................................. 24

Screening and Diagnostic Recommendations .................................................................................................. 25

Vision Screening ............................................................................................................................................................. 25

Color Vision Testing........................................................................................................................................................ 26

Peripheral Vision Testing................................................................................................................................................ 28

Depth Perception ........................................................................................................................................................... 29

Foreign Bodies, Rust Rings, and Corneal Abrasions ......................................................................................... 32

Related Terms ................................................................................................................................................................ 32

Overview ........................................................................................................................................................................ 32

Risk and Causation ......................................................................................................................................................... 32

Signs and Symptoms ...................................................................................................................................................... 33

Red Flags ........................................................................................................................................................................ 33

Job Analysis and Prevention ........................................................................................................................................... 33

Diagnosis ........................................................................................................................................................................ 37

Diagnostic Recommendations ........................................................................................................................................ 38

Treatment Recommendations ....................................................................................................................................... 45

Follow-Up Visits ............................................................................................................................................................. 61

Traumatic Injuries ............................................................................................................................................ 61

Overview ........................................................................................................................................................................ 61

Infections and Corneal Ulcers .......................................................................................................................... 65

Related Terms ................................................................................................................................................................ 65

Overview ........................................................................................................................................................................ 65

Risk and Causation ......................................................................................................................................................... 65

Signs and Symptoms ...................................................................................................................................................... 66

Red Flags ........................................................................................................................................................................ 66

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Diagnosis ........................................................................................................................................................................ 67

Diagnostic Recommendations ........................................................................................................................................ 69

Treatment ...................................................................................................................................................................... 71

Blepharoconjunctivitis ..................................................................................................................................... 78

Overview ........................................................................................................................................................................ 78

Treatment Recommendations ....................................................................................................................................... 78

Allergic Disorders ............................................................................................................................................. 80

Related Terms ................................................................................................................................................................ 80

Overview ........................................................................................................................................................................ 80

Risk and Causation ......................................................................................................................................................... 80

Signs and Symptoms ...................................................................................................................................................... 81

Red Flags ........................................................................................................................................................................ 81

Diagnosis ........................................................................................................................................................................ 81

Treatment ...................................................................................................................................................................... 84

Keratoconjunctivitis ......................................................................................................................................... 91

Chemical Burns ................................................................................................................................................ 91

Overview ........................................................................................................................................................................ 91

Prevention ...................................................................................................................................................................... 91

Education ....................................................................................................................................................................... 91

Treatment Recommendations ....................................................................................................................................... 91

Thermal Burns .................................................................................................................................................. 99

Overview ........................................................................................................................................................................ 99

Treatment Recommendations ..................................................................................................................................... 100

Pterygium ....................................................................................................................................................... 108

Overview ...................................................................................................................................................................... 108

Treatment Recommendations ..................................................................................................................................... 108

References ..................................................................................................................................................... 112

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Summary of Recommendations

Test/Procedure/Treatment

Details

Recommendation

Adenovirus Screening, Routine Use for Infectious

Conjunctivitis

Not Recommended, Insufficient Evidence (I)

Adenovirus Screening, Select Patients for

Infectious Conjunctivitis

Recommended, Evidence (C)

Topical Anesthetics for Corneal Abrasions, Rust

Rings, and Foreign Bodies

Moderately Recommended, Evidence (B)

Antibiotics for Bacterial Conjunctivitis and Bacterial

Infections Complicating Corneal Ulcers

Moderately Recommended, Evidence (B)

Antibiotics for Blepharoconjunctivitis

Recommended, Insufficient Evidence (I)

Antibiotics for Viral Conjunctivitis

Not Recommended, Insufficient Evidence (I)

Prophylactic Ophthalmic Antibiotics for Organic

Matter Injuries

Recommended, Insufficient Evidence (I)

Prophylactic Ophthalmic Antibiotics for Simple

Corneal Abrasion, Rust Rings, and Foreign Bodies

No Recommendation, Insufficient Evidence (I)

Antifungal Medications for Fungal Conjunctivitis

and Fungal Infections Complicating Corneal Ulcers

Recommended, Evidence (C)

Prophylactic Ophthalmic Antifungals for Routine

Prophylaxis of Simple Corneal Abrasions, Rust

Rings, and Foreign Bodies

Not Recommended, Insufficient Evidence (I)

High Molecular Weight Specific Antigens

Strongly Recommended, Evidence (A)

Low Molecular Weight Specific Antigens

Not Recommended, Insufficient Evidence (I)

Antihistamine and/or Mast Cell Stabilization

Medications for Allergic Diseases

Strongly Recommended, Evidence (A)

Artificial Tears or Lubrication for Chemical Ocular

Burns

Recommended, Insufficient Evidence (I)

Artificial Tears or Lubrication for Extensive Corneal

Abrasions, Rust Rings, and Foreign Bodies

Recommended, Insufficient Evidence (I)

Artificial Tears or Lubrication for Thermal Ocular

Burns

Recommended, Insufficient Evidence (I)

Computed Tomography

CT for Evaluation of Ocular Foreign Body and

Possible Orbital Fracture

Recommended, Insufficient Evidence (I)

Contact Lenses

Therapeutic Contact Lens for Corneal Abrasions,

Rust Rings, and Foreign Bodies

Not Recommended, Evidence (C)

Depth Perception Screening for Periodic

Surveillance Examinations

Recommended, Evidence (I)

Depth Perception Screening for Preplacement

Examinations

Recommended, Evidence (I)

Depth Perception Screening for Select Post-injury

Examinations

Recommended, Evidence (I)

Depth Perception Screening for Select

Postoperative Examinations

Recommended, Evidence (I)

Adenovirus Screening

Anesthetics, Topical

Antibiotics

Antifungals

Antigens

Antihistamines

Artificial Tears

Depth Perception

Screening

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