Diferencia entre revisiones de «Conjunctival laceration»
(Expand with concise EM-focused content: Seidel test importance, simple vs complex management, open globe rule-out) |
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==Background== | ==Background== | ||
* | *Tear or disruption of the conjunctival membrane from penetrating or blunt [[ocular trauma|eye injury]] | ||
*Conjunctivae have less innervation than cornea → often less painful than corneal injuries | |||
*'''Critical concern:''' Must rule out underlying scleral laceration or [[open globe injury|open globe]] — conjunctival lacerations can mask scleral perforation | |||
==Clinical Features== | ==Clinical Features== | ||
*Full-thickness defect visible in the conjunctiva | |||
*Full-thickness defect in the conjunctiva | *[[Red eye|Chemosis]], subconjunctival hemorrhage | ||
*[[Red eye|Chemosis]] | *Mild-to-moderate discomfort (less than corneal injuries) | ||
*May have associated conjunctival foreign body | |||
==Differential Diagnosis== | ==Differential Diagnosis== | ||
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==Evaluation== | ==Evaluation== | ||
*[[ | *Complete [[eye exam]] including visual acuity | ||
* | *'''Seidel test:''' Apply fluorescein — look for streaming of aqueous (positive = globe perforation) | ||
*CT orbit | *Evert eyelids to look for foreign bodies | ||
*Assess for [[hyphema|traumatic hyphema]], pupil irregularity, or decreased IOP (signs of open globe) | |||
*CT orbit if high-energy mechanism, concern for intraorbital foreign body, or orbital fracture | |||
==Management== | ==Management== | ||
===Simple=== | ===Simple (all of the following)=== | ||
* | *Superficial laceration | ||
* | *<1 cm in length | ||
* | *No other serious intraorbital or ocular injury | ||
* | *Negative Seidel test | ||
*[[Erythromycin]] ophthalmic ointment | *'''Treatment:''' [[Erythromycin]] ophthalmic ointment QID × 5-7 days, ophthalmology follow-up | ||
===Complex=== | ===Complex=== | ||
*Discuss with ophthalmology | *>1 cm, deep, or associated with other ocular injuries | ||
*Positive Seidel test → treat as [[open globe injury|open globe]] (shield eye, NPO, emergent ophthalmology) | |||
*Discuss with ophthalmology — may require surgical repair | |||
==Disposition== | ==Disposition== | ||
*Simple: | *Simple: discharge with erythromycin ointment, ophthalmology follow-up in 1-2 days | ||
*Complex: | *Complex: ophthalmology consult in ED; admit if open globe or requires surgical repair | ||
==See Also== | ==See Also== | ||
*[[Eye Algorithms (Main)]] | *[[Eye Algorithms (Main)]] | ||
*[[Open globe injury]] | |||
*[[Corneal abrasion]] | |||
{{Special lacerations see also}} | {{Special lacerations see also}} | ||
==References== | ==References== | ||
Revisión actual - 01:24 21 mar 2026
Background
- Tear or disruption of the conjunctival membrane from penetrating or blunt eye injury
- Conjunctivae have less innervation than cornea → often less painful than corneal injuries
- Critical concern: Must rule out underlying scleral laceration or open globe — conjunctival lacerations can mask scleral perforation
Clinical Features
- Full-thickness defect visible in the conjunctiva
- Chemosis, subconjunctival hemorrhage
- Mild-to-moderate discomfort (less than corneal injuries)
- May have associated conjunctival foreign body
Differential Diagnosis
Unilateral red eye
- Nontraumatic
- Acute angle-closure glaucoma^
- Anterior uveitis
- Conjunctivitis
- Corneal erosion
- Corneal ulcer^
- Endophthalmitis^
- Episcleritis
- Herpes zoster ophthalmicus
- Inflamed pinguecula
- Inflamed pterygium
- Keratoconjunctivitis
- Keratoconus
- Nontraumatic iritis
- Scleritis^
- Subconjunctival hemorrhage
- Orbital trauma
- Caustic keratoconjunctivitis^^
- Corneal abrasion, Corneal laceration
- Conjunctival hemorrhage
- Conjunctival laceration
- Globe rupture^
- Hemorrhagic chemosis
- Lens dislocation
- Ocular foreign body
- Posterior vitreous detachment
- Retinal detachment
- Retrobulbar hemorrhage
- Traumatic hyphema
- Traumatic iritis
- Traumatic mydriasis
- Traumatic optic neuropathy
- Vitreous detachment
- Vitreous hemorrhage
- Ultraviolet keratitis
^Emergent diagnoses
^^Critical diagnoses
Evaluation
- Complete eye exam including visual acuity
- Seidel test: Apply fluorescein — look for streaming of aqueous (positive = globe perforation)
- Evert eyelids to look for foreign bodies
- Assess for traumatic hyphema, pupil irregularity, or decreased IOP (signs of open globe)
- CT orbit if high-energy mechanism, concern for intraorbital foreign body, or orbital fracture
Management
Simple (all of the following)
- Superficial laceration
- <1 cm in length
- No other serious intraorbital or ocular injury
- Negative Seidel test
- Treatment: Erythromycin ophthalmic ointment QID × 5-7 days, ophthalmology follow-up
Complex
- >1 cm, deep, or associated with other ocular injuries
- Positive Seidel test → treat as open globe (shield eye, NPO, emergent ophthalmology)
- Discuss with ophthalmology — may require surgical repair
Disposition
- Simple: discharge with erythromycin ointment, ophthalmology follow-up in 1-2 days
- Complex: ophthalmology consult in ED; admit if open globe or requires surgical repair
See Also
Special Lacerations by Body Part
- Head
- Hand
- Other
- Bites
- General laceration repair (main)