Corneal perforation

Untreated bacterial keratitis is associated with corneal scarring and potential loss of vision. Corneal perforation may cause the loss of the eye. 

Hyperacute bacterial conjunctivitis is associated with gonococcal infections in sexually active patients. The causative agents are Neisseria gonorrhoeae or N. meningitidis. Prompt work-up and treatment is required, as corneal perforation occurs in 10% of cases within 48 hours.12 An ophthalmologist should complete a conjunctival scraping and susceptibility testing.10... 

Untreated bacterial keratitis is associated with corneal scarring and potential loss of vision. Corneal perforation may occur and the patient may lose the eye. In virulent organisms, this destruction may occur within 24 hours. Central corneal scarring may result in vision loss even after successful eradication of the organism. 

A 10% solution in rabbit eyes has caused pain, conjunctivitis, and corneal vascularization. Dry, powdered resorcinol applied to rabbit eyes has caused necrosis and corneal perforation. 

Miki et al. (2000) used a photopolymerized liquid applied material for sealing corneal perforations. The novel photocrosslinkable methacrylated hyaluronic... 

Cyanoacrylate has been used for sealing corneal perforations, but it is not smooth or malleable, and it exhibits a hard tissue-scratching surface and requires the patient to use a soft contact lens for comfort. Another surgical limitation when using cyanoacrylate is the immediate polymerization on a wet or moist corneal surface, and that property reduces the time allocated for and increases the difficulty in applying the glue to a precise location in a well-controlled manner. 

Miki, D., Dastgheib, K., Pfister-Sereres, A., Smeds, K., Inoue, M., Hathell, D.L., and Grinstaff, M, A photopolymerizable sealant for corneal perforation, Investigative Ophthammology and Visual Science, 2000... 

Table II. Corneal Perforation Seal with MAP Plus Hypan...

The sealing of corneal perforations using whole enucleated bovine eyes required the same attention to tissue preparation. The epithelial layer in the bond area was removed. After the puncture of the cornea, the stroma was rinsed and blotted to remove potentially interfering aqueous humor components. The Hy-pan hydrogel material, which is 80-90% water, was routinely presoaked in PBS. Maximum bond strengths using 53 /ig of MAP per cm2 patch were obtained in 10 min after application. 

A 29-year-old woman with a painful corneal ulcer related to cocaine abuse was found to be putting cocaine powder directly into the affected eye to reduce the pain (162). Her history included prior corneal perforations. 

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

The vessels associated with the phlyctenule also migrate toward the center of the cornea and produce focal neovascularization. Triangular corneal scars with their base at the limbus often form as phlyctenules heal. These scars can be vascularized. Scarring in the central cornea can decrease visual acuity if the phlyctenulosis is long-standing. Corneal perforation in phlyctenulosis is rare but has been reported. 

MaUari PLT, McCarty DJ, DameU M, et al. Increased incidence of corneal perforation after topical fluoroquinolones treatment for microbial keratitis. Am J Ophthalmol 2001 131 131-133. 

Abuse of these medications often results in irreversible corneal damage and visual loss (330). Two patients continued to instil their topical 0.5% tetracaine eye-drops, despite medical advice. The result was bilateral corneal perforation in the first case and a large unilateral desce-metocele in the second. Surgery was required to correct the perforations, but the long-term anatomical and functional results were poor. A third patient had obtained 0.5% tetracaine hydrochloride drops over the counter to relieve discomfort in his eye after colleagues at work had attempted to remove a foreign body from his eye. He had developed chronic toxic keratitis and was persuaded to discontinue the eye-drops. With appropriate treatment the cornea returned to normal. 

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

Hessemer V, Dick B. Viskoelastische Substanzen in der Kataraktchirurgie - Grundlagen und aktuelle Ubersicht. Klin Monatsbl Augenheilkd 1996 208 55-61 Hirst LW, Dejuan E Jr. Sodium hyaluronate and tissue adhesive in treating corneal perforations. Ophthalmology 1982 89 1250-1253... 

Madsen K, Schenholm M, Jahnke G, Tengblad A. Hyaluronate binding to intact corneas and cultured endothelial cells. Invest Ophthalmol Vis Sci 1989b 30 2132-2137 Maguen E, Nesburn AB, Macy JI. Combined use of sodium hyaluronate and tissue adhesive in penetrating keratoplasty of corneal perforations. Ophthalmic Surg 1984 15 55-57 Mandelcorn M. Viscoelastic dissection for relocation of off-axis intraocular lens implant a new technique. Can J Ophthalmol 1995 30 34-35... 

Erlotinib (Tarceva) EGFR 2004 CV, CNS, pulmonary, renal, GI igastric emptying ECG in dog—no effect 6-mhemolytic anemia, ILD, acute renal failiue, hepatotoxicity, GI perforations, corneal perforation and ulceration, bullous, and exfoliative skin disorders... 

A. Sharma, R. Kaur, S. Kumar, P. Gupta, S. Pandav, B. Patnaik, and A. Gupta, Fibrin glue versus N-Butyl-2-cyanoacrylate in corneal perforations. Ophthalmology, 110,291-298,2003. 

Ocular exposure causes immediate pain, lacrimation, and blepharospasm. Without rapid decontamination, within Imin, permanent blindness may occur (EPA, 1985a Pohanish, 2002). In livestock, this is a death sentence, as they cannot survive on the range when blind. Droplets as small as 0.001 ml can cause corneal perforation and blindness (Sidell et al., 1997). 

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