| CORNEAL LACERATION
Signs and Symptoms
The patient with a corneal laceration has experienced significant ocular
trauma, typically from a metallic object such as a hand tool. (Fingernail scratches, for
example, do not usually have enough force to lacerate a cornea.) There is intense pain
initially which may diminish slightly due to corneal desensitization. Patients are
photophobic and lacrimate profusely. There is a significant attendant uveitis and the
anterior chamber is shallow or even flat in a full thickness laceration. Intraocular
pressure generally ranges from 2 to 6 mmHg. Bubbles within the anterior chamber are a key
finding. There is significantly reduced visual acuity. Other associated findings may
include lens dislocation, iridodialysis, and hyphema.
Pathophysiology
A corneal laceration results from direct trauma to the cornea, typically
from a metallic object impacting with sufficient force. There may be either a full
thickness laceration or a partial thickness laceration. A full thickness laceration is
termed a penetrating injury. In full thickness lacerations, there will be a flat chamber.
Seidel’s sign will be present: as fluorescein is added, you will see the aqueous
oozing out from the wound amidst the fluorescein. There may also be bubbles in the
anterior chamber. Damage to the iris may result in an irregularly shaped, unreactive iris.
Additional pressure on the globe may result in extrusion of uveal tissue through the
wound.
Management
The diagnosis of corneal laceration must be made as quickly as possible
with as little intervention as possible. Additionally, a partial thickness laceration must
be differentiated from a full thickness laceration with the use of Seidel’s test.
Intraocular pressure measurement should be avoided in any cases suspected to be full
thickness lacerations, as any pressure applied to the globe may cause uveal tissue to
extrude through the wound. Visual acuity must be taken, if possible. Judicious use of a
topical anesthetic will alleviate patient discomfort and allow the clinician to make an
appropriate diagnosis. Open a fresh bottle to avoid intraocular contamination.
Do not unnecessarily manipulate the eye with a full thickness
laceration. A topical antibiotic solution may be judiciously applied. Absolutely avoid
pressure patch or bandage contact lens. Use an eye shield to protect the eye. Again, exert
no pressure upon the eye. Arrange for the corneal laceration to be surgically repaired by
a corneal specialist immediately. Instruct the patient to neither eat nor drink prior to
the surgical consultation.
Clinical Pearl
With full thickness corneal lacerations, the less done in
the office the better. Assess the injury, arrange for the appropriate referral, and shield
the eye gently for protection while the patient is in transit to the surgeon.
With a corneal laceration, the patient frequently is
lacrimating too heavily for the Seidel test to be performed with any degree of accuracy.
In these cases, a shallow or flat anterior chamber or the presence of bubbles within the
anterior chamber indicates a breach in the corneal integrity.
Advise the patient that the initial entering acuity may
represent the best vision that the patient can expect to achieve after surgical repair. Of
course, vision may improve after surgical repair; however, it is best not to elevate a
patient’s expectations.
Other reports in this section
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