Laceration, Corneoscleral ?>

Laceration, Corneoscleral

Laceration, Corneoscleral

Introduction
Background

A corneoscleral laceration may occur following blunt or penetrating ocular trauma. This eye injury may be sustained at work, during sports, following a motor vehicle accident, from airbag inflation, or in a brawl. The laceration may be the only injury. The uvea, the retina, or the vitreous may prolapse through the wound. Corneal or scleral tissue may be lost. A corneoscleral laceration is more likely to occur in an eye that has undergone a previous surgery, such as radial keratotomy or corneal transplantation.

Frequency
United States

The exact incidence of corneoscleral laceration in the United States is unknown, but the overall estimated rate of all eye injuries ranges from 8.2-13 per 1000 population. Eye injury rates are highest among individuals in their 20s, males, and whites.1,2
International

The incidence rate worldwide is unknown.
Mortality/Morbidity

Predicting the visual outcome in patients with corneoscleral lacerations is difficult. The outcome is generally poor in patients who have poor visual acuity at presentation, in patients with delayed presentation, and in patients who sustain agricultural-related injuries.
Sex

Corneoscleral lacerations are more common in young men than in young women.
Age

Corneoscleral lacerations are most common in young adults. Wound dehiscences after ocular surgery, such as cataract surgery and corneal transplantation, are most common in older patients.
Clinical
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 their use of safety glasses 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 histories should be obtained. Immunization status for tetanus should be included.
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.
Patients should be asked about other symptoms, such as headache, eye pain, nausea, or vomiting.
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.
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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