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Corneal Laceration Treatment & Management

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

Prehospital Care

Cover the patient's eye with an eye shield or polystyrene/paper cup and avoid any pressure to the globe.

Instruct the patient to move the eyes as little as possible.

Administer antiemetic and analgesic medication in order to reduce pressure on the globe.

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Emergency Department Care

Perform an examination to ascertain the extent of the corneal, anterior chamber, ocular, and associated injuries (eg, facial, cranial).

Ophthalmologic consultation is indicated to address the practitioner's findings and to decide on the appropriate treatment and timing of ophthalmologic evaluation.

Place a protective eye shield (prefabricated or custom made) on the injured eye. This can be a commercial plastic eye shield or simply a polystyrene/paper cup taped over the eye. Do not use an eye patch.

Administer antiemetics and systemic analgesic medication.

Primary tetanus immunization or booster is indicated.

In consultation with the ophthalmologist, discuss the administration of antibiotics including route (topical or intravenously) and frequency.

In general, topical analgesia and antibiotics should be avoided if a corneal laceration is suspected or confirmed. Use systemic analgesia and antibiotics. Topical anesthetics may be used, if needed, to facilitate visual acuity testing and the slit lamp examination.

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Consultations

Ophthalmologic consultation is necessary. The two practitioners must decide and document when and where the consultation will occur. An ophthalmologist will determine the best form of management for the laceration, whether a medical or surgical approach.

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Medical Care

For a small self-sealing corneal laceration, a bandage adhesive soft contact lens may be applied for approximately 3-6 weeks.[41] This will be kept in place in addition to a protective shield until the area heals.

Tissue adhesives have also been used with good success.[41] This should be reserved for select small puncture wounds and lacerations with little to no loss of central tissue.

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Surgical Care

Surgical management is usually required to repair a corneal laceration, remove foreign bodies, and prevent further damage. The goal is to create a watertight wound, minimize scarring, and restore normal anatomic relationship.

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Complications

Retinal detachment, infection, secondary glaucoma, phthisis bulbi, and vision loss are potential complications.

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Contributor Information and Disclosures
Author

Adedoyin Adesina, MD Resident Physician, Department of Emergency Medicine, Kings County Hospital Center, State University of New York Downstate Medical Center

Adedoyin Adesina, MD is a member of the following medical societies: American College of Emergency Physicians, American Medical Association, Association of Nigerian Physicians in America, Emergency Medicine Residents' Association

Disclosure: Nothing to disclose.

Coauthor(s)

Mark A Silverberg, MD, MMB, FACEP Assistant Professor, Associate Residency Director, Department of Emergency Medicine, State University of New York Downstate College of Medicine; Consulting Staff, Department of Emergency Medicine, Staten Island University Hospital, Kings County Hospital, University Hospital, State University of New York Downstate Medical Center

Mark A Silverberg, MD, MMB, FACEP is a member of the following medical societies: American College of Emergency Physicians, American Medical Association, Council of Emergency Medicine Residency Directors, Society for Academic Emergency Medicine

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.

Douglas Lavenburg, MD Clinical Professor, Department of Emergency Medicine, Christiana Care Health Systems

Douglas Lavenburg, MD is a member of the following medical societies: American Society of Cataract and Refractive Surgery

Disclosure: Nothing to disclose.

Chief Editor

Barry E Brenner, MD, PhD, FACEP Professor of Emergency Medicine, Professor of Internal Medicine, Program Director for Emergency Medicine, Case Medical Center, University Hospitals, Case Western Reserve University School of Medicine

Barry E Brenner, MD, PhD, FACEP is a member of the following medical societies: Alpha Omega Alpha, American Heart Association, American Thoracic Society, Arkansas Medical Society, New York Academy of Medicine, New York Academy of Sciences, Society for Academic Emergency Medicine, American Academy of Emergency Medicine, American College of Chest Physicians, American College of Emergency Physicians, American College of Physicians

Disclosure: Nothing to disclose.

Additional Contributors

William K Chiang, MD Associate Professor, Department of Emergency Medicine, New York University School of Medicine; Chief of Service, Department of Emergency Medicine, Bellevue Hospital Center

William K Chiang, MD is a member of the following medical societies: American Academy of Clinical Toxicology, American College of Medical Toxicology, Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Andrew A Aronson, MD, FACEP Vice President, Physician Practices, Bravo Health Advanced Care Center; Consulting Staff, Department of Emergency Medicine, Taylor Hospital

Andrew A Aronson, MD, FACEP is a member of the following medical societies: American College of Emergency Physicians, Massachusetts Medical Society, Society of Hospital Medicine

Disclosure: Nothing to disclose.

Acknowledgements

Andrew A Aronson, MD, FACEP Vice President, Physician Practices, Bravo Health Advanced Care Center; Consulting Staff, Department of Emergency Medicine, Taylor Hospital

Andrew A Aronson, MD, FACEP is a member of the following medical societies: American College of Emergency Physicians, Massachusetts Medical Society, and Society of Hospital Medicine

Disclosure: Nothing to disclose.

Wesley S Grigsby, MD Medical Director, Associate Clinical Professor, Department of Emergency Medicine, Creighton University School of Medicine

Disclosure: Nothing to disclose.

Jerome FX Naradzay, MD, FACEP Medical Director, Consulting Staff, Department of Emergency Medicine, Maria Parham Hospital; Medical Examiner, Vance County, North Carolina

Jerome FX Naradzay, MD, FACEP is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Nelson M Yang, MD Resident Physician, Department of Emergency Medicine, Allegheny General Hospital

Disclosure: Nothing to disclose.

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