J Emerg Med
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The herpes B virus is a zoonotic agent that is endemic among macaque monkeys only, but can cause fatal encephalomyelitis in humans. ⋯ A 26-year-old female presented to a U.S. emergency department after being bitten by a wild macaque monkey. The emergency medicine team administered rabies immunoglobulin and rabies vaccine. The team also prescribed acyclovir for prophylactic coverage against herpes B, a deadly zoonotic agent that is endemic among macaque monkeys. A discussion of background, exposure, transmission, symptoms, treatment for herpes B, including latest data available, literature, and Centers for Disease Control and Prevention guidelines are included. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Zoonotic exposures can cause infectious diseases, which are unfamiliar and deadly. The emergency physician's knowledge of the association between the deadly herpes B infection and wild macaque monkey may expedite treatment and be instrumental in patient morbidity and survival.
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Despite the fact that topical anesthetics provide superb analgesia to the painful eye, they are not prescribed routinely to patients when they are discharged from the emergency department because of concerns for delayed healing and corneal erosion. ⋯ Limited available data suggests that the use of dilute topical ophthalmologic proparacaine or tetracaine for a short duration of time is effective, though their safety for outpatient use is inconclusive.
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Despite the fact that topical anesthetics provide superb analgesia to the painful eye, they are not prescribed routinely to patients when they are discharged from the emergency department because of concerns for delayed healing and corneal erosion. ⋯ Limited available data suggests that the use of dilute topical ophthalmologic proparacaine or tetracaine for a short duration of time is effective, though their safety for outpatient use is inconclusive.
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Review Meta Analysis
Safety and Effectiveness of Topical Anesthetics in Corneal Abrasions: Systematic Review and Meta-Analysis.
Topical anesthetics are used in the emergency department (ED) to relieve eye pain and allow eye examinations in patients with corneal abrasions. There is concern for delayed corneal healing, which is associated with the long-term use of topical anesthetics, so outpatient use is not recommended. ⋯ There were no differences regarding pain, persistent symptoms, or corneal healing when comparing short-term use of topical anesthetics to placebo in the treatment of corneal abrasion. Data on safety are sparse, and the use of this treatment is currently not supported by evidence.
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Review Meta Analysis
Safety and Effectiveness of Topical Anesthetics in Corneal Abrasions: Systematic Review and Meta-Analysis.
Topical anesthetics are used in the emergency department (ED) to relieve eye pain and allow eye examinations in patients with corneal abrasions. There is concern for delayed corneal healing, which is associated with the long-term use of topical anesthetics, so outpatient use is not recommended. ⋯ There were no differences regarding pain, persistent symptoms, or corneal healing when comparing short-term use of topical anesthetics to placebo in the treatment of corneal abrasion. Data on safety are sparse, and the use of this treatment is currently not supported by evidence.