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Corneal/Scleral Trauma 213

PROGNOSIS & OUTCOME • Superficial vascularization occurs in response Technician Tips
to superficial corneal or external ocular Digital photography is a simple but useful tool
disease.
VetBooks.ir • In corneal injury, corneal vascularization ○ Superficial blood vessels arise from the therapy. Diseases and Disorders
• Prognosis and outcome vary, depending on
for monitoring progression and response to
the underlying cause.
conjunctiva, cross the limbus, are bright
red, and branch frequently.
denotes progression toward healing and
is therefore a positive sign, provided the • Deep vascularization occurs in response to SUGGESTED READING
Violette NP, et al: Intracorneal stromal hemorrhage in
underlying problem can be controlled or deep corneal or intraocular disease. dogs and its associations with ocular and systemic
eliminated. ○ Deep blood vessels arise from the ciliary disease: 39 cases. Vet Ophthalmol 20:27-33, 2017.
circulation, disappear at the limbus, and AUTHOR: Lynne S. Sandmeyer, DVM, DVSc, DACVO
PEARLS & CONSIDERATIONS appear darker red and straight. EDITOR: Diane V. H. Hendrix, DVM, DACVO
Comments
It may be useful to distinguish between
superficial and deep vascularization:

Corneal/Scleral Trauma Client Education
Sheet

BASIC INFORMATION ○ Hyphema and/or subconjunctival If so, the exam should also determine whether
hemorrhage the lesion is partial or full thickness (affects
Definition ○ Corneal edema with or without cellular prognosis).
Ocular injury secondary to blunt or sharp infiltrate
trauma. Penetrating infers partial-thickness ■ Uveal prolapse: appears as pigmented Differential Diagnosis
injury; perforating infers full-thickness injury. structure in damaged cornea or sclera; If traumatic event not witnessed, consider
Simple wounds involve only the cornea or associated with dyscoria (misshapen other causes:
sclera; complicated wounds involve multiple pupil) and/or fibrin and hyphema • Corneal ulceration
ocular structures. ○ Foreign body embedded in cornea or • Uveitis
perforating cornea • Hyphema
Epidemiology ○ Signs of uveitis, particularly with perforat-
SPECIES, AGE, SEX ing trauma (p. 1023) Initial Database
Dogs more frequently than cats, but any breed, ○ Fibrin, light tan to yellow, in cornea may • Assess vision: menace response, dazzle reflex,
either sex fill perforation; may be associated with direct and consensual pupillary light reflexes
blood (p. 1137)
RISK FACTORS ○ Yellowish/whitish lens material in • Cytologic evaluation and aerobic culture and
• Young, active animals anterior chamber and cataract if lens is sensitivity of wound
• Hunting animals damaged • CBC, serum biochemistry profile, uri-
• Interanimal fighting ○ Shallow anterior chamber if wound nalysis for preanesthetic purposes if surgery
• Dog’s head out the window while car is in actively leaking necessary
motion • Thorough exam of the entire conjunctival sac
• Existing visual impairment may predispose is necessary to identify any retained foreign Advanced or Confirmatory Testing
material. Sedation, general anesthesia, or • Consider ocular ultrasound exam to deter-
Clinical Presentation referral may be required in difficult cases mine extent of intraocular involvement,
HISTORY, CHIEF COMPLAINT or if this procedure is unfamiliar to the presence of intraocular foreign body, or
• Owner may or may not observe trauma or practitioner. posterior globe rupture.
causal event. • Subconjunctival hemorrhage and hyphema • Orbital radiographs or CT to determine
• Dog might have run through dense or dry should alert clinician to possibility of presence or path of foreign body if suspected
vegetation just before onset of clinical signs. posterior scleral rupture if no anterior • Seidel test to determine if cornea or scleral
• Acute onset of any or all of the following: segment lesions are present, particularly if wound is sealed: apply dry fluorescein strip
○ Blepharospasm accompanied by very low intraocular pressure carefully to surface of wound to cover surface
○ Ocular discharge (<10 mm Hg). with stain; leaking aqueous appears as a green
○ Blood or fluid coming from eye rivulet.
○ Swelling around the eye (e.g., eyelids; Etiology and Pathophysiology
conjunctiva) • Variable; usually traumatic (sharp or blunt) TREATMENT
○ Cloudy eye in origin
• Foreign body may be retained in laceration. Treatment Overview
PHYSICAL EXAM FINDINGS Goals of treatment:
• Signs of pain on ophthalmic exam (p. 1137) DIAGNOSIS • Remove foreign bodies if present.
manifested by blepharospasm and resistance • Repair lacerations that penetrate > 50%
to exam Diagnostic Overview of the thickness of the corneal stroma or
• Linear, V-shaped, or stellate corneal lesion History and exam suggest the diagnosis; an perforate the cornea or sclera.
of acute onset accompanied by any or all of ophthalmic exam helps define whether the • Eliminate infection.
the following: cornea and/or sclera has/have been damaged. • Control intraocular inflammation.

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