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Corneoscleral Laceration Clinical Presentation

  • Author: Guruswami Giri, MD, FRCS; Chief Editor: Hampton Roy, Sr, MD  more...
 
Updated: Jul 05, 2016
 

History

Obtaining a thorough history about the traumatic event is important. The place, the time, and the activity that caused the injury must be elicited. Events after the injury, including any first-aid measures, should also be noted. Patients should be asked about the use of safety glasses in work-related eye injuries. Patients should be queried about other injuries, especially head injuries. Even if patients deny them, they must be carefully evaluated for such injuries. Life-threatening injuries must be managed first.

Medical and surgical history

Medical and surgical histories should be obtained. Immunization status for tetanus should be included.

Past ocular history

Past ocular history is required in patients with corneoscleral injuries. Dates and particulars of previous eye examinations or school vision screenings may help the physician in understanding the status of the eye prior to the trauma. History of amblyopia (lazy eye), eye patching, and muscle surgery for strabismus must be ascertained. Any previous trauma and/or eye surgery should also be included.

Other symptoms

Patients should be asked about other symptoms, such as headache, eye pain, nausea, or vomiting.

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Physical

A good history helps the physician in performing an appropriate physical examination.

In conscious and cooperative patients, visual acuity should be obtained. Visual acuity at the bedside may be obtained with reading cards. In the presence of ecchymosis and lid swelling, a wire speculum may be used after instilling topical anesthetics, but no external pressure should be placed on the eye.

The anterior segment is ideally examined with a slit lamp. Pay particular attention to the corneoscleral laceration. The location and the length of the laceration should be noted. If the intraocular contents prolapse through the laceration, the rest of the eye examination should be deferred and performed in the operating room. Measurement of the intraocular pressure is also deferred because any pressure on the globe can result in extrusion of the intraocular contents.

The size and the shape of the pupil and its reaction should be checked. Whenever possible, the pupils should be checked for a relative afferent pupillary defect.

Confrontation visual fields must be assessed.

The fellow eye should be carefully evaluated, including a dilated fundus examination.

After a corneoscleral laceration is diagnosed, an eye shield is applied, and the head of the bed is elevated.

Pain, nausea, and vomiting must be appropriately managed.

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Causes

A corneoscleral laceration may occur following blunt or penetrating ocular trauma. Patients who have undergone previous ocular surgery may develop a wound rupture with relatively mild trauma.

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Contributor Information and Disclosures
Author

Guruswami Giri, MD, FRCS Vitreo-Retinal Surgeon, Sacramento, CA

Guruswami Giri, MD, FRCS is a member of the following medical societies: American Academy of Ophthalmology, Royal College of Surgeons of Edinburgh, Royal College of Ophthalmologists

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Christopher J Rapuano, MD Professor, Department of Ophthalmology, Jefferson Medical College of Thomas Jefferson University; Director of the Cornea Service, Co-Director of Refractive Surgery Department, Wills Eye Hospital

Christopher J Rapuano, MD is a member of the following medical societies: American Academy of Ophthalmology, American Ophthalmological Society, American Society of Cataract and Refractive Surgery, Contact Lens Association of Ophthalmologists, International Society of Refractive Surgery, Cornea Society, Eye Bank Association of America

Disclosure: Serve(d) as a director, officer, partner, employee, advisor, consultant or trustee for: Cornea Society, Allergan, Bausch & Lomb, Bio-Tissue, Shire, TearScience, TearLab<br/>Serve(d) as a speaker or a member of a speakers bureau for: Allergan, Bausch & Lomb, Bio-Tissue, TearScience.

Chief Editor

Hampton Roy, Sr, MD Associate Clinical Professor, Department of Ophthalmology, University of Arkansas for Medical Sciences

Hampton Roy, Sr, MD is a member of the following medical societies: American Academy of Ophthalmology, American College of Surgeons, Pan-American Association of Ophthalmology

Disclosure: Nothing to disclose.

Additional Contributors

Stephen D Plager, MD 

Stephen D Plager, MD is a member of the following medical societies: American College of Surgeons, American Medical Association, American Society of Cataract and Refractive Surgery, California Medical Association

Disclosure: Nothing to disclose.

References
  1. McGwin G Jr, Hall TA, Xie A, et al. Trends in eye injury in the United States, 1992-2001. Invest Ophthalmol Vis Sci. 2006 Feb. 47(2):521-7. [Medline].

  2. McGwin G Jr, Xie A, Owsley C. Rate of eye injury in the United States. Arch Ophthalmol. 2005 Jul. 123(7):970-6. [Medline].

  3. Ryan SJ, Allen AW. Pars plana vitrectomy in ocular trauma. Am J Ophthalmol. 1979 Sep. 88(3 Pt 1):483-91. [Medline].

  4. Brinton GS, Topping TM, Hyndiuk RA, et al. Posttraumatic endophthalmitis. Arch Ophthalmol. 1984 Apr. 102(4):547-50. [Medline].

  5. Essex RW, Yi Q, Charles PG, et al. Post-traumatic endophthalmitis. Ophthalmology. 2004 Nov. 111(11):2015-22. [Medline].

  6. Schemmer GB, Driebe WT Jr. Posttraumatic Bacillus cereus endophthalmitis. Arch Ophthalmol. 1987 Mar. 105(3):342-4. [Medline].

  7. Barr CC. Prognostic factors in corneoscleral lacerations. Arch Ophthalmol. 1983 Jun. 101(6):919-24. [Medline].

  8. Albert DM, Jakobiec FA. Principles and Practice of Ophthalmology. WB Saunders Co; 2000. Vol 6: 5179-5217.

 
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