Prehospital Care
Cover the patient's eye with an eye shield or polystyrene/paper cup and avoid any pressure to the globe.
Instruct the patient to move the eyes as little as possible.
Administer antiemetic and analgesic medication in order to reduce pressure on the globe.
Emergency Department Care
Perform an examination to ascertain the extent of the corneal, anterior chamber, ocular, and associated injuries (eg, facial, cranial).
Ophthalmologic consultation is indicated to address the practitioner's findings and to decide on the appropriate treatment and timing of ophthalmologic evaluation.
Place a protective eye shield (prefabricated or custom made) on the injured eye. This can be a commercial plastic eye shield or simply a polystyrene/paper cup taped over the eye. Do not use an eye patch.
Administer antiemetics and systemic analgesic medication.
Primary tetanus immunization or booster is indicated.
In consultation with the ophthalmologist, discuss the administration of antibiotics including route (topical or intravenously) and frequency.
In general, topical analgesia and antibiotics should be avoided if a corneal laceration is suspected or confirmed. Use systemic analgesia and antibiotics. Topical anesthetics may be used, if needed, to facilitate visual acuity testing and the slit lamp examination.
Consultations
Ophthalmologic consultation is necessary. The two practitioners must decide and document when and where the consultation will occur. An ophthalmologist will determine the best form of management for the laceration, whether a medical or surgical approach.
Medical Care
For a small self-sealing corneal laceration, a bandage adhesive soft contact lens may be applied for approximately 3-6 weeks. [41] This will be kept in place in addition to a protective shield until the area heals.
Tissue adhesives have also been used with good success. [41] This should be reserved for select small puncture wounds and lacerations with little to no loss of central tissue. Cyanoacrylate glue can be used to repair small corneal lacerations. Fibrin glue has been found to be a safe and effective alternative to suture in some cases of corneal lacerations. [42]
Surgical Care
Surgical management is usually required to repair a corneal laceration, remove foreign bodies, and prevent further damage. The goal is to create a watertight wound, minimize scarring, and restore normal anatomic relationship.
Complications
Patients with corneal laceration may develop retinal detachment, infection, secondary glaucoma, phthisis bulbi, and/or vision loss.
Postoperative complications include corneal scarring, pigmentation, cataract formation, and endophthalmitis. [35]
Prevention
Patients that engage in activities that place their eyes at risk for trauma should be encouraged to wear protective eyewear at all times.
Further Outpatient Care
Small full-thickness corneal lacerations require careful outpatient follow-up similar to partial thickness corneal injuries.
Further Inpatient Care
Definitive care is determined at the time of the initial ophthalmologic consultation and will take place in the setting of the patient’s overall condition.
A patient who sustains a corneal laceration as part of other trauma may have to be evaluated in the hospital for the other injuries.
Larger full-thickness lacerations require hospitalization, surgical management, and intravenous antibiotics.
