Corneoscleral Laceration Clinical Presentation

Updated: Nov 19, 2018
  • Author: Guruswami Giri, MD, FRCS; Chief Editor: Hampton Roy, Sr, MD  more...
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Presentation

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, especially 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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Complications

The following complications are associated with corneoscleral lacerations:

  • Endophthalmitis, which occurs in 2-7% of patients with ocular trauma

  • Iris damage

  • Glaucoma, which can occur acutely or later, possibly related to angle recession

  • Epithelial downgrowth

  • Fibrous ingrowth

  • Cystoid macular edema

  • Sympathetic ophthalmia, which can occur anytime after the trauma (One case of sympathetic ophthalmia occurred 50 years after the initial trauma.)

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