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Corneal Tear Repair

Updated: Jul 23, 2023

A case of a 9 year old boy who came to the emergency after injury with his own glass spectacles.

The tear extended from 5 o clock to 10 o clock with a curved pattern. The uveal tissue was prolapsed.

He was immediately taken up for primary wound closure.

-Full thickness corneal lacerations of more than 2mm require to be sutured to close the wound.

-The needle should enter the cornea perpendicular to the tissue when passing a suture.

-Sutures should be passed at 90% depth in the stroma because too shallow can lead to posterior wound gape.

-Full-thickness passes can become a track for microorganisms to enter the eye.

-The suture is tied with a slip knot (3-1-1).

-Compression zones: triangular extensions from the suture, to ensure there are no gaps.

-Long sutures will have a large zone of compression compared to shorter sutures.

-Long sutures should be passed in the periphery to steepen the cornea centrally and seal the wound.

-Centrally the sutures are in the visual axis.

-Placing short sutures centrally with minimal suture tension will reduce astigmatism and prevent excess scarring.

-When there is a tissue prolapse, it has to be reposited back into the eye before suturing.

-Create a paracentesis away from the wound inject viscoelastic.

-Use a cyclodialysis spatula to pull the iris back into the eye through a sweeping motion.

-Sutures have to be buried to hide the knot.

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