The cornea is the transparent, dome-shaped front window of the eye. A corneal rupture, or full-thickness laceration, means the outer coat of the eye has been breached. This severe ocular emergency compromises the eye’s structural integrity, allowing internal fluids to escape and exposing delicate tissues to the external environment. Immediate medical intervention is required to save the eye and preserve vision.
Mechanisms of Injury and Primary Causes
Corneal ruptures most often occur through two mechanical pathways: blunt force trauma or penetrating injury. Blunt trauma, such as impact from a ball, an airbag, or a fist, causes a sudden increase in intraocular pressure. This pressure spike forces the globe to tear at its weakest point, often extending from a previous surgical incision or a naturally thin area.
Penetrating trauma involves a sharp object slicing directly through the corneal layers, creating a full-thickness laceration. The severity of this injury is determined by the size, shape, and velocity of the object, and whether it remains lodged within the eye.
Ruptures can also occur spontaneously due to pre-existing conditions that weaken the corneal structure. Severe infectious keratitis, caused by bacteria or fungi, leads to aggressive corneal thinning and perforation. Autoimmune disorders, such as rheumatoid arthritis, can cause peripheral ulcerative keratitis. Prior eye surgery, like a corneal transplant, leaves weaker scar tissue susceptible to rupture from minor trauma.
Immediate Signs and Emergency Steps
A corneal rupture is typically accompanied by sudden, severe eye pain and immediate vision loss. Characteristic signs include a visible tear on the eye surface, sometimes with clear or cloudy fluid leaking from the wound. This fluid leakage, known as aqueous humor, can cause the anterior chamber to flatten.
Other signs include an irregular or peaked pupil, where the iris tissue is pulled toward the laceration site. Blood visible in the front of the eye, termed hyphema, is also common following traumatic rupture. Any suspicion of this injury requires immediate first-aid steps before reaching emergency care.
The most important instruction is to avoid any pressure on the injured eye; do not rub, wash the eye, or attempt to remove a foreign object. Applying pressure can cause the expulsion of internal eye contents. The injured eye should be gently covered with a protective shield, such as a clean paper cup taped over the bony orbit, to prevent accidental contact. Also, avoid taking non-steroidal anti-inflammatory drugs (NSAIDs) like aspirin, as these increase the risk of internal bleeding.
Surgical Repair and Acute Treatment
Urgent surgical intervention is required to restore the globe’s structural integrity and prevent infection. The primary goal is to create a watertight closure of the wound, ideally within 24 hours of the injury. This prompt action reduces the risk of endophthalmitis, a severe internal eye infection.
For most significant lacerations, the surgeon performs a primary repair using non-dissolving nylon sutures. Sutures are placed to align the corneal tissue layers, ensuring the wound edges are approximated. The pattern and tension of the sutures are adjusted to restore the natural curve of the cornea, minimizing post-operative astigmatism.
In cases where the laceration is small (typically less than two millimeters), the surgeon may use medical-grade tissue adhesive. This glue, often reinforced with a bandage contact lens, seals the perforation and allows natural healing without sutures. During repair, any internal tissue that has prolapsed through the wound, such as the iris, must be carefully managed. Viable tissue is gently repositioned, but damaged or contaminated tissue must be excised to prevent complications.
The operation also addresses other acute injuries sustained during the trauma, such as a damaged lens requiring cataract removal. Following repair, the patient receives topical antibiotics to combat potential infection. Topical steroids are also given to control inflammation caused by the trauma and surgery.
Post-Operative Recovery and Visual Outcomes
The recovery process following corneal rupture repair is protracted and requires monitoring over several months. Initially, the eye remains protected by a shield, and the patient adheres to a schedule of antibiotic and steroid eye drops to manage infection and inflammation. Sutures typically remain in place for several weeks to months, often six weeks or longer, before an ophthalmologist begins to remove them individually.
Suture removal is a gradual process intended to relieve tension and reduce the irregular astigmatism they induce, which is a common cause of blurry vision after repair. Even with successful repair, patients face risks from long-term complications, including traumatic glaucoma, retinal detachment, or the development of a secondary cataract, where the lens becomes cloudy.
The final visual prognosis depends on the initial severity and location of the wound; a rupture involving the central visual axis carries a worse outlook. Significant corneal scarring, which appears as a dense white opacity, can permanently block light from reaching the retina. If the resulting vision is functionally poor due to scarring or severe irregular astigmatism, further intervention is necessary.
Intervention may include a corneal transplant, known as keratoplasty, to replace the scarred tissue with a clear donor cornea. Specialized, rigid gas-permeable contact lenses may also be used to optically neutralize the irregular surface.