In a pediatric patient with a conjunctival infection, fluorescein staining under Wood lamp suggests a corneal issue. What is the most appropriate next step?

• A. Evert the eyelids
• B. Start topical antibiotics
• C. Arrange urgent ophthalmology consult
• D. Perform a CT scan of the orbit

Answer: (A)

When fluorescein staining indicates a corneal involvement, the first priority is to thoroughly examine the eye to identify the exact source of the problem. Evert the upper eyelid to inspect the palpebral conjunctiva and lid margins for a hidden foreign body or lid-edge pathology that could be irritating the cornea. Hidden debris or a tiny foreign body on the underside of the lid is a common cause of corneal staining and can be easily missed unless the lid is flipped. If you find a foreign body, remove it with proper technique and address any resulting corneal abrasion with appropriate topical antibiotic therapy and follow-up. If no foreign body or lid pathology is found but the cornea is involved, you can proceed with treatment for a corneal abrasion and monitor closely, escalating to ophthalmology if there are signs of deeper infection or vision threat. CT imaging isn’t indicated in this scenario, and starting antibiotics without reassessing the eye’s surface could miss a removable cause of the problem.