Managing a partial-thickness laceration
A 28-year-old white male presented with the complaint of a scratched right eye. He reported that earlier that day, he had been working on a construction project and was hammering a piece of plastic when the plastic splintered and hit him in the right eye.
A 28-year-old white male presented with the complaint of a scratched right eye. He reported that earlier that day, he had been working on a construction project and was hammering a piece of plastic when the plastic splintered and hit him in the right eye. He described that initially there was a stabbing pain, and then the eye began watering profusely. A Seidel test was negative, and he was prescribed topical Ciloxan (ciprofloxacin, Bayer) to be used every hour while awake.
Follow-up the next day
The patient returned the following morning for a scheduled follow-up visit. He complained of severe watering, photophobia, foreign body sensation, and redness OD. Uncorrected visual acuity was 20/20- OD. There was a severe ptosis OD, Grade 2-3+ conjunctival injection, and a 4 mm linear opacity directly under the visual axis. Surrounding the linear opacity was epithelial and stromal edema. The anterior chamber was fully formed. The slit lamp appearance is shown in Figure 1.
There was also a 3+ anterior chamber reaction as shown in Figures 2 and 3. For the follow-up, fluorescein was instilled to inspect the linear opacity. The appearance of the fluorescein staining is demonstrated in Figure 4.
The opacity had re-epithelialized overnight and had both positive and negative stain. A repeat Seidel test was negative. The exterior lid was evaluated and then everted to inspect for a retained conjunctival foreign body. Papillae (Grade 2+) were present, but there was no foreign body.
Anterior segment optical coherence tomography (ASOCT) was then performed at the site of the wound. A line scan at the deepest part of the wound is shown in Figure 5.
Upon further investigation, the pupil was sluggish but reacted to light. Intraocular pressure (IOP) by applanation tonometry was 11 mm Hg. A careful dilated fundoscopic evaluation showed no sign of a retained intraocular foreign body.