|Year : 1984 | Volume
| Issue : 5 | Page : 307-309
Non-surgical management of penetrating corneal injuries
Gullapalli N Rao, M Srinivasan
Cornea Research Laboratory and DepartmentofOphthalmology, University ofRochester Medical Centre, Rochester, USA
Gullapalli N Rao
M.D, 919 Westfall Road, Rochester, NY 14618-2699
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Rao GN, Srinivasan M. Non-surgical management of penetrating corneal injuries. Indian J Ophthalmol 1984;32:307-9
Ocular trauma can involve different parts of the eye and one of the most common forms is penetrating corneal injuries. These injuries can vary from a small perforation to an extensive laceration. The therapeutic strategy in these cases should include attention to all factors that can influence the ultimate outcome of such an injury. Although the definitive treatment for extensive corneal lacerations is surgical, there is a place for other modalities of treatment in some selected situations. The two known non-surgical modalities that can be applied in the management of penetrating corneal injuries are the usage of hydrophilic bandage lenses and the application of cyanoacrylate adhesive.
For purposes of management, corneal lacerations can be divided into simple and complicated types.
Simple corneal lacerations are those where the wound is clear cut with good apposition of the edges without incarceration of any tissue. These wounds usually heal very rapidly and result in a clean scar with a minimal effect on the corneal clarity or refractive status.
In contrast, complicated corneal lacerations are characterized by poor apposition, very often associated with incarceration of intraocular structures. The edges are poorly apposed with possibility of wound gape, irregular scar, and higher degrees of astigmatism. For obvious reasons, only simple lacerations are amenable to non-surgical treatment.
Hydrophilic Bandage Lenses
Hydrophilic contact lenses were initially introduced in 1967 and their potential for therapeutic purposes has been recognized since the early 1970's. A number of investigators have conclusively demonstrated the beneficial effects of these lenses in the treatment of a variety of corneal diseases including the management of small corneal wounds and perforations.' In making the determination to use hydrophilic bandage lenses in these cases, one has to be aware of the potential risks associated with this modality of treatment.
| Indications|| |
1) partial thickness lacerations; 2) Small perforations; 3) Full thickness lacerations up to 3-4mm in size. All those wounds should be of the simple type. 4) Wound leak following surgical closure of wounds
Prior to fitting, a careful evaluation of the ocular status including the status of lids, tear film, and corneal sensitivity is important. Once the decision has been made to proceed with the usage of lenses. the lens should be fitted steep. This may sometimes lead to the steep lens syndrome resulting in considerable discomfort to the patient. The patient should be told of this possibility in advance and the problem should be treated promptly. One may have to continue with the usage of these lenses with appropriate treatment for the inflammatory reaction in the eye. The beneficial effect of the lens very often becomes obvious immediately with deepening of the anterior chamber.
The follow-up care should include the instillation of topical antibiotics such as chloromycetin drops and in some cases, cycloplegics and steroids. The patient should be checked at 1 hour, l day, 3 days, 7 days, and every 2 weeks for 3 months. The usage of the lens should be continued until evidence is seen for adequate healing of the wound. An additional beneficial effect of this modality is the improvement of visual acuity.
All complications known to occur with extended wear of hydrophilic lenses can occur. In eyes with debilitating problems and keratoconjunctivitis sicca, one has to be aware of the escalation of risk for infection.
| Cyanoacrylate adhesive|| |
This is a monomer which has the characteristic of instantaneous polymerization on contact with a small amount of water of weak base. These monomers form an exceptionally strong bond that may last for weeks to months and help to accelerate the normal tissue healing processes in the cornea. The use of this modality in the treatment of corneal problems is now well accepted. When it is applied to a normal cornea, a mild to moderate reaction can occur in the conjunctiva. This may lead to rapid reepithelialization as well as stromal healing.
Mechanism of Action
1. Acceleration of healing process by invasion of blood vessels.
2. preventing the destructive action of proteolytic enzymes on the stroma.
1. Small, ragged wounds.
2. Small perforations.
3. Simple lacerations less than 3mm in size.
4. Lacerations with minimal loss of substance.
5. Leaking wounds following surgical repair.
1. Simple procedure.
2. Can be performed as an outpatient procedure.
3. Can be repeated several times.
4. In those patients who are poor risks for any surgical procedures.
1. Possibility for dislodgment. 2. Subjective discomfort.
The procedure is simple and is performed in the following manner.
1. A few drops of adhesive have to be withdrawn into the syringe.
2. A drop of topical anesthetic should be instilled into the patient's eye.
3. The lids are kept open by a speculum.
4. Necrotic tissue and epithelium in and around the wound should be removed.
5. A drop of the adhesive is then applied and allowed to solidify.
6. A hydrophilic lens is then applied to cover this area.
7. A drop of antibiotic is applied in the eye.
The adhesive may have to be left in place for about 8-12 weeks. The patient should be seen weekly during this time. Topical cycloplegics and steroids may be given depending on the degree of inflammatory reaction.
| Summary and conclusion|| |
The s quelae of some of the small and simple corneal lacerations can be avoided by simple non-surgical management of these problems. Proper patient selection and follow-up are of paramount importance to minimize the risk of complications.
| References|| |
Aquavella J.V., Jackson G.K and Guy L.F., 1971. Ann. Ophthalmol. 1341-1350.
Rao G.N. In: Contact Lenses: Ed. Dabezies O.. in press.
Dohlman C, Refojo M, Webster R and Richards J., 1970. Excerpta Medica, series 222, Ophthalmology: 1292.