Scleral Laceration
- Cut in sclera
- Usually caused by sharp instrument but similar lacerations can result from blunt trauma
- May extend through partial or full thickness of sclera
- History of lacerating or blunt trauma
- Pain and perhaps blurred vision
- May be small or hidden behind bloody, swollen conjunctiva
- Irregular pupil may be clue that iris plugs hole in sclera
- Blunt trauma to eye, BUT... deformed eye and irregular pupil suggest perforation
- Inflammation or allergy, BUT... no history of trauma
- Suspect orbital fracture in anyone with exposure to severe blunt face trauma plus reduced vision,
- Suspect scleral laceration if there is pain, reduced vision, or lid swelling
- Do not pry lids apart for detailed exam as you may expel contents of eye
- Place shield over orbit and refer emergently to ophthalmologist
- Even ophthalmologists cannot confidently exclude scleral lacerations under swollen conjunctiva, so patients often taken into surgery for exploration
- Even partial thickness lacerations must be promptly sutured under general anesthesia
- Delayed closure risks eye infection
- Visual outcome depends on extent of laceration and damage to other parts of eye