Mohammad Zeyad Mohammad Ayoub¹ and Saeed Azizi²

Western Eye Hospital, 153-173 Marylebone Road, London NW1 5QH, UK

Croydon University Hospital, 530 London Road, Thornton Heath CR7 7YE, London, England

Abstract

A gentleman in his 40s presented to eye casualty following trauma from shattered eyeglasses, which caused a full-thickness corneal laceration in his left eye. Slit-lamp examination revealed an approximate 7 mm paracentral wound, 3 mm from the visual axis. There was associated mild vitreous haemorrhage and reduced vision. Seidel test was negative, indicating spontaneous self-sealing of the wound. However, this resulted in significant irregular astigmatism and refractive error, compromising visual acuity. Lens structure was intact, with the presence of fibrin strand from the anterior lens capsule. Urgent surgical repair was performed with interrupted 10-0 nylon sutures to restore anatomical integrity and regularise the corneal contour. The anterior chamber was reformed, and a bandage contact lens was placed. Postoperative management included topical antibiotics, corticosteroids, and lubricants. The early postoperative course was uncomplicated, with a stable wound and maintained visual acuity. This case highlights the importance of recognising self-sealed corneal lacerations, where irregular healing can cause optical distortion, and demonstrates the role of surgical repair in optimising both structural and visual outcomes.

Introduction

Ocular trauma is a leading cause of visual loss and is responsible for an estimated 1.6 million cases of blindness globally (1). Recent data highlight that ocular trauma continues to pose a major public health challenge, particularly in low- and middle-income countries (2). Open globe injuries, including corneal lacerations, are ophthalmic emergencies requiring urgent diagnosis and surgical repair (3).

The prognosis of corneal lacerations depends on factors like wound size, location, associated intraocular damage, timing of surgical repair, and complications such as endophthalmitis or secondary glaucoma (4,5). This report describes a case of a traumatic full-thickness corneal laceration caused by shattered eyeglasses, managed with surgical repair and postoperative therapy.

Case Report

A gentleman in his 40s presented to the emergency department after sustaining ocular trauma to his left eye when his eyeglasses shattered.

On slit-lamp examination, there was a full-thickness paracentral corneal laceration measuring approximately 7 mm in length, about 3 mm from the visual axis. Seidel test was negative, suggesting spontaneous self-sealing of the wound leading to an irregular corneal contour and significant irregular astigmatism, reflected in the marked refractive change on autorefraction (−11.00 DS/−4.50 DC ×132). A fibrin strand was seen from the anterior lens capsule, although the crystalline lens itself was intact. Mild vitreous haemorrhage was present, but the retina was flat with clear media. Best-corrected visual acuity (BCVA) was 6/24 in the affected eye, with OCT of the macula showing a normal contour.

Surgical repair was undertaken within 24 hours under local anaesthesia. The wound edges were debrided. Then the anterior chamber was reformed using balanced salt solution and healon (viscoelastic) and five interrupted 10-0 nylon sutures were placed. A watertight closure was confirmed by Seidel testing. A bandage contact lens was applied. Then, subconjunctival cefuroxime and dexamethasone were used.

Postoperatively he was prescribed- topical moxifloxacin 0.5% four times daily for 2 weeks, dexamethasone 0.1% tapered over 4 weeks, and sodium hyaluronate 0.2% for lubrication. Protective eye shielding was advised. On day one, intraocular pressure was 8 mmHg, with stable wound architecture and no complications. At four weeks, the wound remained secure with sutures in situ, inflammation had subsided, and BCVA was maintained at 6/24.

Discussion

Corneal lacerations are a frequent form of open globe injury, with outcomes depending on early detection and timely surgical repair (6). The primary aims of treatment are to close the wound, restore the eye’s structure, prevent infection, and reduce inflammation (4).

In this case, the corneal wound had spontaneously self-sealed, as demonstrated by the negative Seidel test. While this preserved globe integrity, the irregular closure produced a distorted corneal surface and induced significant irregular astigmatism. This highlights a clinical dilemma: even in the absence of aqueous leakage, surgical repair may be indicated to optimise corneal contour and visual function, as well as to ensure watertight closure.

Timely repair within 24 hours lowers the risk of infection and improves prognosis (7). The surgical steps in this case — debriding wound edges, reforming the anterior chamber, and placing interrupted nylon sutures — not only secured the wound but also improved corneal regularity. Postoperative management with topical fluoroquinolones helped prevent infection, while corticosteroids reduced inflammation, though close monitoring is always required (4).

Visual recovery after corneal laceration depends on wound size, involvement of the visual axis, and whether lens or retinal structures are affected (4). In this case, the intact lens and retina suggested a relatively good outcome. However, paracentral scarring and irregular astigmatism remain important determinants of long-term vision.

Patient education on protective glasses and workplace safety is essential in reducing the risk of preventable eye injuries (1,8).

Conclusion

This case shows successful treatment of a full-thickness corneal laceration from shattered spectacles. Although the wound had spontaneously sealed, surgery was essential to restore anatomical integrity and to regularise the corneal surface, thereby improving visual quality. Prompt surgical repair and careful postoperative care, ensured globe integrity and prevented complications. Prevention remains important, and the use of impact-resistant eyewear is a key step in lowering the global burden of open globe injuries.

References

1. Negrel, A.D. and Thylefors, B. (1998) ‘The global impact of eye injuries’, Ophthalmic Epidemiology, 5(3), pp. 143–169.
2. Bian, X., Xu, S., Song, Y., et al. (2020) ‘Global, national and regional prevalence and associated factors of ocular trauma: a protocol for systematic review and meta-analysis’, Medicine, 99(35), p. e21870.
3. Kuhn, F. and Pieramici, D.J. (2002) Ocular Trauma: Principles and Practice. New York: Thieme.
4. Fujikawa, A., Mohamed, Y.H., Kinoshita, H., et al. (2018) ‘Visual outcomes and prognostic factors in open-globe injuries’, BMC Ophthalmology, 18, p. 138.
5. Rahman, I., Maino, A., Devadason, D. and Leatherbarrow, B. (2019) ‘Open globe injuries: factors predictive of poor outcome’, Eye (London), 33(6), pp. 908–913.
6. Zhou, Y., et al. (2022) ‘Open globe injuries: evaluation, management and surgical pearls’, Clinical Ophthalmology, 16, pp. 1395–1406.
7. McMaster, D., et al. (2024) ‘Early versus delayed timing of primary repair after open-globe injury: a meta-analysis’, Ophthalmology. 2025 Apr;132(4):431-441. doi: 10.1016/j.ophtha.2024.08.030. Epub 2024 Aug 31. PMID: 39218161.
8. Bian, X., Xu, S., Song, Y., et al. (2020) ‘Global, national and regional prevalence and associated factors of ocular trauma: a protocol for systematic review and meta-analysis’, Medicine, 99(35), p. e21870.