Deep Corneal or Scleral Injuries

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These are corneal or scleral injuries caused by sharp objects. 

Clinical presentation 

  • History of injury with a sharp object such as knife or wire
  • Swollen eye
  • Eye discharge

Investigations 

  • Visual acuity
  • Examine  the  injured  eye  with  slit lamp or magnifier

Non-pharmacological Treatment 

  • Apply an eye shield or pad with no pressure and refer immediately

While waiting for referral, use the following in the affected eye: 

Pharmacological Treatment 

A: chloramphenicol 1% eye drop, 2 drops stat 

OR  

A: chloramphenicol 1% ointment, stat 

AND

B: atropine 1%, 1–2 drops stat 

AND 

A: tetanus toxoid (IM) 0.5ml stat as prophylaxis 

AND 

A:  paracetamol  (PO)1gm  4–6hourly  to  a  maximum  of  4  doses  in  24hours,  for  3days  in adults, the dosage in children is 10–14mg/kg 4–6hourly for 3days

Referral indicated if 

  • Intraocular foreign body is suspected
  • There is globe or intraocular penetration evidenced by:
    • Poor vision,
    • Distorted pupil
    • Ocular contents of foreign body is seen
    • Circumferential subconjunctival hemorrhage
    • Hyphaema with or without raised intraocular pressure
  • Conjunctival laceration requiring suturing (>1 cm)
  • Laceration/perforation or diffuse damage to the cornea and sclera
  • Chemical and thermal injuries
  • Damage to ocular adnexa including eyelids
  • Limited ocular movements

Surgical Treatment 

This is done by a well-trained eye specialist at the District, Regional, Zonal and National hospitals. It  should be done within 48 hours of injury. Post-operative care should be monitored regularly for any  signs of endophthalmitis. 

Note: 

  • Eye  ointment  should  be  applied  very  gently  and  in  the  lower  fornix  (behind  the  lower eyelid).
  • Do not apply pressure on the eye in perforating injuries of the eyeball

Delay  in  surgical  management  of  the  injury  may  cause  irreversible  blindness  or  may  necessitate  removal of an eye 

Referral: Immediately refer the patient to a health facility with eye surgeon at the District, Regional,  Zonal or National hospital depending on the staff availability.