C. Corneal laceration with uveal prolapse
This patient was found to have a full-thickness corneal laceration with uveal prolapse of the left cornea. A corneal laceration can be either a partial or full thickness injury to the cornea usually caused by trauma with a sharp object, the glass in this case. It requires immediate Ophthalmology consult and surgical repair.
The patient was given a dose of morphine, Zofran, and tetracaine ophthalmic solution. Ah eye shield was also applied. A bedside ultrasound was performed and showed no obvious deformities followed by a CT scan which confirmed no globe deflation or foreign bodies present. Ophthalmology was consulted and took the patient to the operating room and repaired both a corneal and scleral laceration. While on the floor he received IV antibiotic therapy, ampicillin/sulbactam, antibiotic eye drops, and steroid eye drops. He was observed for 48 hours without any signs of infection and cleared for discharge with close ophthalmology follow up.
A Hyphema is a pooling or collection of blood inside the anterior chamber of the eye (the space between the cornea and the iris) and is unlikely in this case as the defect appears outside on the surface of the cornea. A Hypopyon is a pooling or collection of white blood cells or other inflammatory cells in the anterior chamber of the eye and is not seen in the picture above. Vitreous hemorrhage is defined as the presence of blood within the vitreous cavity, which is the space lined posteriorly by the retina and anteriorly by the ciliary body and lens. The substance seen on the surface of the cornea in the picture above is not a Corneal Foreign Body but actually iris extruding from a corneal laceration. In addition, a CT scan of the orbits was obtained in this case which did not show any foreign bodies present.
Willmann D, Fu L, Melanson SW. Corneal Injury. [Updated 2021 Jul 29]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK459283/