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Ophthalmology – Conjunctival and Corneal Lacerations
Conjunctival and corneal lacerations are tears or cuts of the ocular surface caused by blunt or penetrating trauma. These injuries range from superficial partial-thickness defects to full-thickness open globe injuries, which are vision-threatening emergencies. They are more common in young males and are frequently associated with occupational or recreational activities where protective eyewear is not used.
Patients typically present with pain, redness, tearing, photophobia, and foreign body sensation. A careful history is critical, especially regarding the mechanism of injury, as high-velocity trauma (e.g., metal-on-metal or BB gun injuries) raises strong concern for intraocular foreign body (IOFB) or globe rupture. Determining the timing of last oral intake is also important if urgent surgery is required.
On examination, minimal manipulation of the eye is essential to avoid worsening a possible open globe injury. Visual acuity should always be checked, but intraocular pressure must not be measured if a full-thickness laceration is suspected. Slit-lamp examination helps assess the size, depth, and location of the wound. Fluorescein staining can highlight epithelial defects, and a positive Seidel test confirms aqueous leakage, indicating a full-thickness laceration. Additional concerning signs include irregular pupil, shallow or deep anterior chamber, hyphema, hypotony, or vitreous hemorrhage. Both eyes must be examined carefully, and eyelid eversion should be performed when safe.
If an intraocular foreign body is suspected, orbital CT scan (thin cuts) is the imaging modality of choice, while MRI should be avoided if metallic material is possible. Even with normal imaging, persistent suspicion of globe injury may require surgical exploration.
Management depends on the severity of the injury. Small conjunctival lacerations without scleral involvement often heal with topical antibiotic ointment alone, while larger ones may require suturing. Partial-thickness corneal lacerations are treated with topical antibiotics and close observation, though some may need suturing if wound edges gape. In contrast, full-thickness corneal lacerations are ophthalmic emergencies requiring urgent surgical repair in the operating room. Patients should be protected with a rigid eye shield, kept NPO, and given systemic antibiotics to reduce infection risk. Antiemetics and pain control are important to prevent increases in intraocular pressure.
Surgical repair focuses on restoring globe integrity, carefully repositioning tissues, removing vitreous traction if present, and achieving watertight closure using fine sutures. Associated injuries such as traumatic cataract or iris damage are usually addressed later. Patients must be counseled about the rare but serious risk of sympathetic ophthalmia, which can affect the uninjured eye.
Close follow-up is required to monitor for complications such as infection, retinal detachment, or wound leakage. Children are at particular risk of amblyopia, requiring prompt visual rehabilitation. Prognosis varies widely depending on the severity of injury, timing of treatment, and presence of complications, with worse outcomes associated with delayed care or severe trauma.
Conjunctival and corneal lacerations are tears or cuts of the ocular surface caused by blunt or penetrating trauma. These injuries range from superficial partial-thickness defects to full-thickness open globe injuries, which are vision-threatening emergencies. They are more common in young males and are frequently associated with occupational or recreational activities where protective eyewear is not used.
Patients typically present with pain, redness, tearing, photophobia, and foreign body sensation. A careful history is critical, especially regarding the mechanism of injury, as high-velocity trauma (e.g., metal-on-metal or BB gun injuries) raises strong concern for intraocular foreign body (IOFB) or globe rupture. Determining the timing of last oral intake is also important if urgent surgery is required.
On examination, minimal manipulation of the eye is essential to avoid worsening a possible open globe injury. Visual acuity should always be checked, but intraocular pressure must not be measured if a full-thickness laceration is suspected. Slit-lamp examination helps assess the size, depth, and location of the wound. Fluorescein staining can highlight epithelial defects, and a positive Seidel test confirms aqueous leakage, indicating a full-thickness laceration. Additional concerning signs include irregular pupil, shallow or deep anterior chamber, hyphema, hypotony, or vitreous hemorrhage. Both eyes must be examined carefully, and eyelid eversion should be performed when safe.
If an intraocular foreign body is suspected, orbital CT scan (thin cuts) is the imaging modality of choice, while MRI should be avoided if metallic material is possible. Even with normal imaging, persistent suspicion of globe injury may require surgical exploration.
Management depends on the severity of the injury. Small conjunctival lacerations without scleral involvement often heal with topical antibiotic ointment alone, while larger ones may require suturing. Partial-thickness corneal lacerations are treated with topical antibiotics and close observation, though some may need suturing if wound edges gape. In contrast, full-thickness corneal lacerations are ophthalmic emergencies requiring urgent surgical repair in the operating room. Patients should be protected with a rigid eye shield, kept NPO, and given systemic antibiotics to reduce infection risk. Antiemetics and pain control are important to prevent increases in intraocular pressure.
Surgical repair focuses on restoring globe integrity, carefully repositioning tissues, removing vitreous traction if present, and achieving watertight closure using fine sutures. Associated injuries such as traumatic cataract or iris damage are usually addressed later. Patients must be counseled about the rare but serious risk of sympathetic ophthalmia, which can affect the uninjured eye.
Close follow-up is required to monitor for complications such as infection, retinal detachment, or wound leakage. Children are at particular risk of amblyopia, requiring prompt visual rehabilitation. Prognosis varies widely depending on the severity of injury, timing of treatment, and presence of complications, with worse outcomes associated with delayed care or severe trauma.
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