Corneal Laceration Workup
- Author: Adedoyin Adesina, MD; Chief Editor: Barry E Brenner, MD, PhD, FACEP more...
No laboratory studies are useful for detecting the presence of a corneal laceration.
Radiography, CT, or MRI may be indicated to identify intraocular or intraorbital foreign bodies or associated orbital, cranial, or facial trauma. MRI should generally be avoided if there is suspicion for a metallic foreign body. However, it may be of some use if organic foreign body (eg, wood, plant matter) is suspected. MRI may be difficult to obtain on an emergent basis.
Thin-slice CT scanning is the preferred imaging modality for evaluation of suspected globe rupture. CT scanning can also be used to evaluate for other forms of associated head or facial trauma.
The globe and its contents can be imaged via ultrasonography. When using ultrasonography, plenty of gel should be applied to the eye so that the examining physician can place the probe in the gel but avoid putting pressure on the eye itself. Ultrasonography can be used to evaluate for globe rupture, lens dislocation, foreign body, retrobulbar hemorrhage, and retinal detachment. However, ultrasonography is contraindicated when globe rupture is suspected. A 2002 study showed that ultrasonography has a sensitivity of 100% and specificity of 97.2% in diagnosing orbital pathology such as globe rupture, retrobulbar hemorrhage, retinal detachment, and lens dislocation.
Radiography may be used to evaluate for additional facial fractures. However, many facilities have CT scanning readily available, which is more sensitive for finding such injuries.
Seidel test may be useful for detecting corneal lacerations.
Slit lamp biomicroscopy is essential.
Ultrasound biomicroscopy (UBM) may be performed to confirm architecture of the laceration. UBM is a noninvasive diagnostic tool that provides in vivo imaging of the anterior segment in high resolution and with great depth of penetration. It allows visualization of the structures posterior to the iris.
Anterior-segment optical coherence tomography (ASOCT) generates in vivo, high-resolution, cross-sectional imaging and is used to evaluate the structure of the anterior chamber. It can also be used to detect the extent of a laceration and presence of globe rupture. As opposed to UBM, ASOCT cannot visualize structures posterior to the iris such as the ciliary body, zonules, and the peripheral lens.
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