On the first postoperative day after uncomplicated LASIK, a patient reports glare. Slit lamp shows fine white granular cells scattered at the flap-stromal interface with a clear periphery and visual acuity of 6/9. The BEST initial management is:

• A Immediate flap lift and irrigation
• B Frequent topical corticosteroid drops with close review ✓
• C Topical broad-spectrum antibiotic hourly
• D Bandage contact lens insertion

Explanation

This is stage 1 diffuse lamellar keratitis (DLK, Sands of Sahara), a sterile inflammatory reaction at the interface appearing within the first few days after LASIK. Early stages respond well to intensive topical corticosteroids with daily review. Flap lift and interface irrigation is reserved for dense stage 3 or 4 disease with clumping and visual loss. Antibiotics do not help because DLK is not infectious, and a bandage lens is irrelevant after LASIK.

Reference: Yanoff and Duker, Ophthalmology, 5th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.