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Information

Symptoms

Pain, redness, and/or foreign body sensation, with a history of trauma.

Signs

Fluorescein staining of the conjunctiva. The conjunctiva may be torn and rolled up on itself. Exposed white sclera may be noted. Conjunctival and subconjunctival hemorrhages are often present.

Workup

  1. History: Determine the nature of the trauma and whether a ruptured globe or intraocular or intraorbital foreign body may be present. Evaluate the mechanism for possible foreign body involvement, including size, shape, and velocity of object.
  2. Complete ocular examination, including careful exploration of the sclera (after topical anesthesia, e.g., proparacaine or viscous lidocaine) in the region of the conjunctival laceration to rule out scleral laceration or subconjunctival foreign body. The entire area of sclera under the conjunctival laceration must be inspected. Since the conjunctiva is mobile, inspect a wide area of the sclera under the laceration. Use a proparacaine-soaked, sterile cotton-tipped applicator to manipulate the conjunctiva. Irrigation with saline may be helpful in removing scattered debris. A Seidel test may be helpful (see APPENDIX 5, SEIDEL TEST TO DETECT A WOUND LEAK). Cellulose surgical spears may be helpful for detecting vitreous through a wound. Dilated fundus examination, especially evaluating the area underlying the conjunctival injury, must be carefully performed with indirect ophthalmoscopy.
  3. Consider a CT scan of the orbit without contrast (axial, coronal, and parasagittal views, 1-mm sections) to exclude an intraocular or intraorbital foreign body. B-scan ultrasound or UBM may be helpful.
  4. Exploration of the site in the operating room under general anesthesia may be necessary when a ruptured globe is suspected, especially in children.

Treatment

In case of a ruptured globe or penetrating ocular injury, see 3.14, RUPTURED GLOBE AND PENETRATING OCULAR INJURY. Otherwise,

  1. Antibiotic ointment (e.g., erythromycin, bacitracin, or bacitracin/polymyxin B q.i.d.). A pressure patch may rarely be used for the first 24 hours for comfort.
  2. Most lacerations will heal without surgical repair. Some large lacerations (≥1 to 1.5 cm) may be sutured with 8-0 polyglactin 910 (e.g., Vicryl) or 6-0 plain gut. When suturing, take care not to bury folds of conjunctiva or incorporate Tenon capsule into the wound. Avoid suturing the plica semilunaris or caruncle to the conjunctiva.

Follow Up

If there is no concomitant ocular damage, patients with large conjunctival lacerations are reexamined within 1 week. Patients with small injuries are seen at longer intervals and instructed to return immediately if symptoms worsen.