Conjunctival laceration
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)