How to sample the cornea
1) Check visual
2) Check able to blink
3) Check under lid margins for extra hairs lumps and bumps
4) Look behind third eye lid for foreign bodies
5) Sample cornea
a. Sedate
b. AP block, frontal block - wait 5minutes
c. Multiple applications of proxymetacine (x10 over 1 min then roll proxy soaked cotton bud back and forth over area until no reaction
d. Sterile bact swab – firmyl debride abnormal area – trying to remove epithelial cells – if they strip off easily this tells you have an area of indolent ulceration (which can be primary or 2nd to corneal necrosis, recurrent ocular trauma eg ectopic hair, chronic corneal oedema and an underlying stromal abscess) – send swab for bact and sens including fungal culture – we use our own lab but any good commercial lab will do
e. Take 2nd sterile bacterology swab (or even better a cytobrush) and firmly rub the exposed stroma (or epithelium if did not all come off when rubbed with first swab) – roll swab or cytobrush on to 2 cleaned slides and send to cytopath fao Emma Scurrel
download submission form here
f. Cover with Chloramphenicol and serum/plasma QD whilst wait for results