SCLERAL AND LIMBIC LACERATIONS

Course overview

SCLERAL AND LIMBAL LACERATIONS ARE A FORM OF OPEN GLOBE INJURIES ASSOCIATED WITH SIGNIFICANT VISUAL LOSS. THE LACERATIONS USUALLY RESULT FROM SHARP AND POINTED OBJECTS LIKE SCISSORS, THORNS, IRON NAILS, FISH HOOKS, WOOD PIECES, ETC. THE CLINICAL MANIFESTATIONS INCLUDE CONJUNCTIVAL CONGESTION, SUBCONJUNCTIVAL HEMORRHAGE, BREACH IN THE CONTINUITY OF SCLERA OR CORNEAL LIMBUS (PARTIAL OR FULL THICKNESS), IRIS PROLAPSE, AND PEAKING OF THE PUPIL, BREACH IN THE ANTERIOR LENS CAPSULE. THERE MAY OR MAY NOT BE ASSOCIATED VITREOUS PROLAPSE. THE FINDINGS MAY BE VARIABLY PRESENT AND DIFFER FROM CASE TO CASE. THE DIAGNOSIS IS CLINICAL, AND THE SEIDELS TEST IS USED PREOPERATIVELY TO ASSESS THE AQUEOUS LEAK. IMAGING IS INDICATED POSTOPERATIVELY AND IN PATIENTS WITH AN ASSOCIATED INTRAOCULAR FOREIGN BODY. THESE CONDITIONS MUST BE PROMPTLY DIAGNOSED AND TREATED TO MINIMIZE IRREVERSIBLE VISUAL IMPAIRMENT AND CONTRALATERAL OCULAR INFLAMMATION. THE TREATMENT IS SURGICAL, AND THE LACERATION MUST BE SUTURED WITH 9-0 OR 10-0 NYLON SUTURES TO HAVE A GOOD ANATOMICAL AND FUNCTIONAL OUTCOME. THE PROGNOSIS IS GOVERNED BY TEAR LENGTH AND THE NATURE OF THE INJURY. THIS ACTIVITY REVIEWS THE ESSENTIAL CLINICAL FINDINGS ASSOCIATED WITH THE EVALUATION AND TREATMENT OF SCLERAL AND LIMBAL LACERATIONS. IT DICTATES THE ROLE OF THE INTERPROFESSIONAL TEAM IN MANAGING PATIENTS WITH THIS CONDITION.