Treatment for Corneal Laceration
The treatment for corneal laceration requires immediate surgical intervention with corneal suturing for full-thickness lacerations, combined with topical antibiotics to prevent infection and reduce the risk of vision loss. 1
Assessment of Corneal Laceration
Classification by Depth
- Partial-thickness (lamellar) laceration: Involves only part of the corneal thickness
- Full-thickness laceration: Complete penetration through all corneal layers, often with leakage of aqueous humor (positive Seidel test)
Key Clinical Features to Evaluate
- Depth and extent of laceration
- Presence of foreign bodies
- Anterior chamber status (depth, presence of hypopyon)
- Intraocular pressure
- Associated injuries (iris, lens, retina)
- Visual acuity
Treatment Algorithm
1. Immediate Management
For full-thickness lacerations:
- Urgent surgical repair with corneal suturing 1
- Placement of a protective shield (not patch) to prevent further injury
- Avoid pressure on the globe
For partial-thickness (lamellar) lacerations:
- Repositioning of displaced corneal flaps and securing with sutures 2
- For small, stable lamellar lacerations: may be managed with bandage contact lens and close monitoring
2. Antimicrobial Therapy
- Broad-spectrum topical antibiotics to prevent infection:
- Fluoroquinolones (e.g., moxifloxacin 0.5%) or
- Combination of fortified antibiotics for severe cases 1
- Continue for at least 1-2 weeks or until epithelialization is complete
3. Pain Management
- Topical cycloplegic agents (e.g., cyclopentolate) to reduce ciliary spasm and pain 1
- Oral analgesics as needed
- Important: Never prescribe topical anesthetics for home use 3
4. Additional Measures
For impending perforation or small perforation:
- Application of tissue adhesive (cyanoacrylate) 1
- Note: The base must be dry for proper adhesion
- Bandage contact lens placement over the adhesive
For cases with significant corneal edema:
Special Considerations
Amniotic Membrane Transplantation
- Can be used as an "onlay" protective flap or "inlay" tissue substitute 1
- Promotes healing through anti-inflammatory and anti-angiogenic mediators
- Available in forms attached to scleral rings or as wafers placed under contact lenses
Post-LASIK Corneal Lacerations
- Require special care to avoid manipulating the LASIK flap during repair 4
- May need specialized surgical approach to maintain flap integrity
Potential Complications
- Infectious keratitis
- Corneal scarring affecting vision
- Irregular astigmatism
- Delayed healing
- Secondary glaucoma
Follow-up Care
- Frequent monitoring (daily initially) to assess healing and detect complications
- Gradual tapering of medications based on clinical response
- Consider corneal topography to evaluate for irregular astigmatism
- Visual rehabilitation with spectacles, contact lenses, or in severe cases, corneal transplantation for visually significant scarring
Prevention
- Protective eyewear for high-risk activities
- Patient education about eye safety
- Prompt treatment of corneal epithelial defects to prevent progression
Remember that delayed treatment of corneal lacerations can lead to serious complications including endophthalmitis, corneal scarring, and permanent vision loss. The visual outcome depends on the location, size, and depth of the laceration, as well as the timeliness and appropriateness of treatment.