Corneal laceration

Ointments should be used with caution in jagged or flap-like corneal lacerations, in eyes with impending corneal perforation, and in open conjunctival lacerations. 

During the examination, and when considering the history of the traumatic episode, it is important to rule out corneal laceration or penetration, retained foreign bodies, or other ocular traumatic sequelae. Clean corneal abrasions should not exhibit opaque infiltration suggestive of bacterial or fungal keratitis. 

Any sharp object that injures the eye with sufficient farce can cause a corneal laceration in which the stroma is penetrated to any depth. Corneal penetration occurs if the object or foreign body passes completely through the cornea. Objects that may cause lacerating or penetrating... 

A careful history helps to reveal the etiology of the traumatic event, although the possibility of corneal laceration or penetration may not be determined definitively from the history alone. Patient symptomatology associated with deep corneal injuries may vary widely. In the event of a small corneal penetration that has self-sealed, associated symptomatology may be relatively minor. More extensive involvement may produce symptoms of pain, photophobia, tearing, or blepharospasm. 

Figure 26-24 Corneal laceration arrow). (Courtesy of Pat Caroline.)...

After surgical repair of a corneal laceration, visual rehabilitation may be obtained with the fitting of a contact lens, even with prominent central scarring and sutures intact. This is especially necessary to help retain binocularity and... 

Cosar CB, Rapuano CJ, Cohen EJ. Corneal laceration and intraocular foreign body in a post-LASIK eye. Cornea 2002 21 234-236. 

Lemp MA. The use of sodium hyaluronate (Healon) in the removal of corneal foreign body with a perforating corneal laceration. Cornea 1982 1 357-358 Lerner HA, Boynton JR. Sodium hyaluronate (Healon ) as an adjunct to lacrimal surgery (letter to the editor). Am J Ophthalmol 1985 99 365... 

In a second experiment, Ayers and Stahl studied the effects of discharging a CS pen-gun cartridge into a rabbit eye at a distance of 20 cm. At that distance, the wad caused less damage than the blast and the particles of CS. Only three of 10 animals suffered severe eye lesions, which appeared to combine mechanical damage (lacerations) from the wad and conjunctivitis, intraocular hemorrhage, keratitis, and corneal edema probably from the blast and CS particles driven into the eye. The other animals showed only mild conjunctivitis, which cleared after 3 d. 

One obvious concern in the event of a lamellar laceration or corneal penetration is the insult to the regularity and clarity of the corneal surface and the potential impact on visual acuity.This issue also affects the method chosen for repair. In the case of corneal penetration, there is also concern about intraocular foreign bodies, damage to intraocular structures, and, most importantly, the risk of polymicrobial endophthalmitis. 

Ointments should not be used in cases of comeal laceration, corneal perforation and where comeal surgery is contemplated. 

HEALTH SYMPTOMS Inhalation (irritates eyes, skin, and respiratory system) eyes (corneal bums) skin (skin bums, lacerations) ingestion (headache, dizziness). 

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