2020–2021 BCSC Basic and Clinical Science Course™
8 External Disease and Cornea
Chapter 14: Clinical Aspects of Toxic and Traumatic Injuries of the Anterior Segment
Penetrating and Perforating Ocular Trauma
It is important to understand the difference between a penetrating wound and a perforating wound for accurate communication and documentation. In a penetrating wound, a foreign body passes into an anatomical structure; in a perforating wound, a foreign body passes through such a structure. In a penetrating corneal injury, an object enters but does not pass all the way through the cornea, as in the case of a metallic foreign body that enters the corneal stroma but lodges anterior to the Descemet membrane. In a perforating corneal injury, an object passes through the cornea and lodges in the anterior chamber. A perforating corneal foreign-body injury can also be called a penetrating ocular foreign-body injury if the foreign body passes through the cornea but does not exit through the globe. In a perforating ocular injury, the foreign body enters and exits the globe.
When managing conjunctival lacerations associated with trauma, the physician must be certain that the deeper structures of the eye have not been damaged and that no foreign body is present. After a topical anesthetic has been applied, the conjunctival laceration should be explored under slit-lamp examination using sterile forceps or cotton-tipped applicators. If any question remains as to whether the globe has been penetrated, consideration must be given to exploration in the operating room. In general, small linear conjunctival lacerations do not need to be sutured. However, stellate conjunctival lacerations, lacerations with bare sclera exposed, or lacerations with lost or retracted conjunctival tissue will heal faster if sutured closed.
Excerpted from BCSC 2020-2021 series: Section 10 - Glaucoma. For more information and to purchase the entire series, please visit https://www.aao.org/bcsc.