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How Do I Treat a Corneal Perforation?

By Marco Sumayao
Updated Mar 03, 2024
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The treatment of a corneal perforation, in which the thin transparent outer layer of the eye is ruptured, begins with a Seidel test to determine the presence of serious damage. If no leakage or deformities are detected, doctors advise patients to keep the damaged eye under a protective cover. Patients will need to use medicated eye drops to both heal and disinfect the wound. Patients should also avoid touching the affected eye to prevent exacerbating the injury. If the corneal perforation is deemed too serious for home care, doctors might recommend a lamellar keratoplasty, in which the damaged tissue is replaced with donor tissue.

A corneal perforation can cause varying degrees of discomfort for the patient, depending on the size, location, and depth of the injury. Some patients will find the pain manageable, while others will find it intolerable. If at any point an individual suspects he has a corneal perforation, he should immediately go to the nearest ophthalmology clinic and undergo a Seidel test.

During the Seidel test, doctors will apply a small fluorescein strip over the general area of the wound. If any discoloration appears on the eye, it is an indication of leaking aqueous humor from underneath the cornea, and subsequently, of a corneal perforation. The test can sometimes be used to pinpoint the location of cornea damage, as well as determine the gravity of the injury. Doctors can examine the fluorescein strip through a cobalt blue filter to obtain more definitive results.

In most cases, treating a corneal perforation involves applying a topical medication and protecting the eye from further harm. Doctors often prescribe medication that encourages proper tissue healing and prevents scarification. The medicine is often used in conjunction with antiseptic eye drops to prevent infection. The damaged eye should be protected from any external contact, as well as exposure to light — patients often wear eye patches, gauze, or protective caps to help. The time it takes for the wound to heal depends largely on the patient's system and eye care regimen, although most cases last about two to three weeks.

In cases where the corneal perforation has caused a significant amount of damage, doctors will recommend a lamellar keratoplasty. The surgical procedure involves replacing the damaged parts of the patient's anterior corneal stroma and Bowman's membrane with tissue from a donor. Given the sensitive nature of the procedure, as well as the risk of permanent damage, a lamellar keratoplasty is often used as a last resort for corneal perforation treatment.

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