INTRODUCTION

A corneal laceration is a cut on the cornea. Typically, it is caused by something sharp flying into the eye. It is also caused by something striking the eye with significant force, like a fingernail or metallic fragment or tool. A corneal laceration is deeper than a corneal abrasion, cutting partially or entirely through the cornea. A partial-thickness (lamellar) injury does not violate the globe of the eye. However, a full-thickness wound penetrates altogether through the cornea, causing a ruptured globe. A corneal laceration is a severe injury and requires immediate attention to avoid severe vision loss. A contact lens is often used as a bandage in the treatment of the corneal laceration.

HOW AND WHY DO LACERATIONS OCCUR?

Generally, corneal lacerations are caused by assault, sport, motor vehicle accidents, domestic and industrial accidents as a result of the eye coming in contact with blunt or sharp objects. Penetrating injuries are three times more common in males than females and in the younger age group. The extent of the damage is determined by the size of the object, its speed at the time of impact and its composition.

MANAGEMENT OF CORNEAL LACERATIONS

The history of the patient sometimes points to a discrete event after which the patient’s symptoms started. Of immediate and paramount importance is the introduction of infection with any foreign object. Slit-lamp examination under high magnification is essential to evaluate corneal lacerations. In addition, the Seidel test which is sodium fluorescein staining under cobalt blue light is vital to assess intra-ocular penetration, and it is especially important to observe the integrity of the anterior chamber. Non-contact tonometry is useful. Low IOP (< 7mmHg) on the side of the injury is indicative of penetrating injury. Standard treatment regimen includes antibiotic-steroid combination drops, cycloplegic drops, and pain medications. Typically, Spersadex Comp qid, Atropine 1% bid, Tramadol 50mg tds po, paracetamol 500mg tds po, are excellent workhorses. Also, broad-spectrum antibiotic ointment is applied. Cyanoacrylate tissue adhesive may be indicated for the treatment of small perforating wounds with poor central apposition or stellate lacerations that do not self-seal. Full-thickness lacerations (globe rupture) greater than 2-3 mm require suturing to structurally restore the globe’s integrity and prevent expulsion of intraocular contents. Extensive lacerations with avulsion and a large amount of tissue loss may eventually require lamellar or penetrating keratoplasty. Ophthalmologists often perform peripheral iridotomy when lacerations extend to the limbus to prevent the formation of anterior synechiae. Bandage soft contact lens may be sufficient for a small self-sealing, beveled or oedematous corneal cut to protect the wound as it heals. Contact lenses made from silicone hydrogel (SiHy) are soft and comfortable to wear for long periods and work well as bandage contact lenses. Bandage lenses are used to relieve eye pain and promote corneal epithelial wound healing. Also, they serve as tectonic structural support while the anterior chamber is reforming. The lenses are worn on an extended wear basis and removed when the corneal laceration has healed.

CLINICAL PEARLS

• Patients are advised not to rinse with water, not to rub or apply pressure to the eye.
• Record visual acuities in both eyes.
• Check that pupils are reactive and circular.
• Always evert the eyelids.
• Examine with fluorescein and use cobalt blue light under high magnification.
• Penetrating corneal injuries usually show positive Seidel test; misshaped iris, hyphaema, decrease in visual acuity and shallow anterior chamber.
• Patients with corneal lacerations will experience pain that is out of proportion to physical injury.
• CT of an orbit is necessary for penetrating eye injuries.
• Penetrating corneal laceration may be at risk for complications, including retinal detachment, intraocular infection, and glaucoma, necessitating follow-up visits.

CONCLUSION

Corneal lacerations are caused by blunt or sharp objects from various sources. Corneal injuries must be treated early to relieve the eye from more severe pain and discomfort. Contact lenses are used in addition to medications.

REFERENCES

1. Friedman NJ, Pineda RB, Kaiser PK. The Massachusetts Eye and Ear Infirmary Illustrated Manual of Ophthalmology. 1st Ed. Philadelphia: WB Saunders Company. 1998. 89-91.
2. Kanski JJ. Clinical Ophthalmology. A Systematic Approach. 5th Ed. London: Butterworth Heinemann. 2003,671-674
3. Vaughan D, Asbury T. General Ophthalmology. 10th Ed. Los Angeles: Lange Medical Publishers. 1983. 39