Corneal Laceration

Updated: May 17, 2016
  • Author: Adedoyin Adesina, MD; Chief Editor: Barry E Brenner, MD, PhD, FACEP  more...
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Overview

Background

A corneal laceration can be a partial- or full-thickness injury to the cornea. A partial-thickness injury does not violate the globe of the eye (abrasion). A full-thickness injury penetrates completely through the cornea, causing a ruptured globe. This topic discusses the full-thickness injury.

History sometimes points to a discrete event after which the patient’s symptoms started; however, this is not always the case. Small foreign bodies, digital trauma, or other more subtle sources of damage may not be quickly recalled by the patient. The physician must be meticulous in examining the cornea and periorbital structures if there is suspicion of a corneal laceration. Typically, patients who present with this type of injury complain of an intensely painful, profusely lacrimating eye.

The first priority in evaluating a corneal injury is to include or exclude a full-thickness injury and the resulting ruptured globe. A full-thickness injury will allow aqueous humor to escape the anterior chamber, which can result in a flat-appearing cornea, air bubbles under the cornea, or an asymmetric pupil secondary to the iris protruding through the corneal defect.

For more information, see Medscape's Cornea and External Disease Resource Center and Medscape's Ophthalmology Specialty page.

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Epidemiology

Frequency

United States

The United States Eye Injury Registry (USEIR) is a terrific resource for nationwide eye trauma epidemiology, prevention techniques, and educational resources.

Approximately 2% of all emergency department visits are due to eye injuries. [34]

Penetrating eye injury can occur in individuals of any age, but data from USEIR demonstrate that the mean age of the patient with an ocular injury is 29 years (median age, 26 y), with nearly 60% being younger than 30 years. [1]

The American Academy of Ophthalmology also has statistics available. These data suggest similar trends to the USEIR data.

The Centers for Disease Control and Prevention/National Institute of Occupational Safety and Health features information pertaining to work-related eye injuries.

More than 90% of eye injuries are preventable with the use of protective eyewear. [34]

International

International epidemiology of penetrating eye injury has similar demographics of who is likely to sustain corneal injury: males, between ages 25 and 30 years, associated with alcohol ingestion, and injury occurring at home. Be aware of any local activities or traditions that may also predispose the local population to corneal injury (eg, fireworks injuries on the Fourth of July in the United States).

Mortality/Morbidity

Mortality from corneal lacerations is rare, but morbidity can be significant. Corneal lacerations or subsequent secondary infection (endophthalmitis) can result in complete or partial loss of vision, loss of the eye, or systemic infection. Other complications include corneal scarring, cataract formation, and secondary glaucoma. [35]

Sex

Males are about 1.7 times more likely than females to have penetrating ocular injury. [34]

Age

Although ocular trauma can occur in persons of all ages, the majority of injuries occur in those aged 25-30 years.

Of patients presenting to the emergency department with eye injury, 45.3% were aged 18-44 years. The highest rate of admission-related eye injuries occurred among persons older than 65 years.

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Prognosis

The prognosis after corneal laceration depends on the extent of the injury. Factors to consider include but are not limited to depth and length of laceration, location, and degree of scarring. Extensive corneal scarring may affect vision, requiring corneal transplant in the future. Laceration involving deeper globe structures such as the lens, retina, and uveal tissue may have a guarded prognosis.

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