Lecture 21 - Trauma to the Conjunctiva

What is a conjunctival abrasion?

An area of superficial tissue damaged by scraping or rubbing, causing tissue disruption without penetration.

What are common causes of a conjunctival abrasion?

Direct trauma or a foreign body within the fornices, such as leaf debris or a rigid contact lens.

What inflammatory response occurs after a conjunctival abrasion?

Conjunctival and episcleral vasodilation with chemosis.

Is a conjunctival abrasion typically unilateral or bilateral?

Typically unilateral.

Does conjunctival abrasion have a racial, gender, or age predilection?

No; however, ocular trauma is more common in men.

What history is usually associated with a conjunctival abrasion?

A history of trauma.

What are the main conjunctival signs of a conjunctival abrasion?

Sectoral hyperemia, possible subconjunctival hemorrhage depending on severity, and positive NaFl/LG staining.

What additional traumatic findings may accompany a conjunctival abrasion?

Lid edema or ecchymosis, uveitis, hyphema, or other trauma-related findings.

What type of discomfort occurs with conjunctival abrasion?

Discomfort is common, but generally not pain.

Why can even severe conjunctival abrasions be minimally symptomatic?

The conjunctiva is much less densely innervated than the cornea or eyelid.

What symptoms may occur with a conjunctival abrasion?

Discomfort, epiphora, cosmetic concern, and haemolacria.

What is haemolacria?

Blood in the tears.

What deeper ocular inflammatory conditions should be differentiated from conjunctival abrasion?

Episcleritis and scleritis.

What is particularly important when differentiating conjunctival abrasion from deeper ocular inflammation?

The patient history.

How should a conjunctival abrasion wound be cleaned?

Irrigate with sterile saline to remove particulate matter or clotted blood.

How should a visible foreign body associated with a conjunctival abrasion be removed?

By the least invasive means possible, such as forceps versus a needle.

What is the natural course of a conjunctival abrasion?

It is a self-limiting condition.

What supportive treatments are used for conjunctival abrasion?

Cold compresses for 24–48 hours and liberal lubrication with artificial tears.

What prophylactic antibiotic drops may be used for conjunctival abrasion?

Moxifloxacin 0.5% BID for 4–7 days.

What prophylactic antibiotic ointment may be used for conjunctival abrasion?

Tobramycin 0.3% TID for 4–7 days.

Is a bandage or dressing usually necessary for a conjunctival abrasion?

No, a bandage or dressing is usually unnecessary.

What is the typical follow-up interval for a conjunctival abrasion?

Return to clinic in 1 week.

What is a conjunctival laceration?

An area of tissue that has been cut or torn open due to blunt force trauma.

What type of trauma can directly cause a conjunctival laceration?

Direct trauma from a sharp object or instrument.

What is the key difference in tissue integrity between a conjunctival abrasion and a conjunctival laceration?

An abrasion causes tissue disruption without penetration, while a laceration involves tissue penetration.

Why does subconjunctival hemorrhage occur with a conjunctival laceration?

Rupture of blood vessels invariably leads to subconjunctival hemorrhage.

What inflammatory response occurs after a conjunctival laceration?

Conjunctival and episcleral vasodilation with chemosis.

What symptoms may occur with a conjunctival laceration?

Variable discomfort, foreign body sensation, excessive tearing, and possibly haemolacria.

When does pain typically occur with a conjunctival laceration?

When collateral ocular damage is present, such as uveitis or a corneal abrasion.

What hyperemia and hemorrhage pattern is characteristic of a conjunctival laceration?

Sectoral hyperemia with subconjunctival hemorrhage.

What does a conjunctival laceration look like clinically?

A visible conjunctival defect overlying bare sclera.

Why do the edges of a conjunctival laceration rapidly roll or curl backward after trauma?

Because of the elastic nature of the conjunctiva.

How does a conjunctival laceration stain?

Positive NaFl/LG staining delineates the lacerated region.

What additional traumatic finding may accompany a conjunctival laceration?

Ecchymosis of the eyelid.

What must be ruled out when evaluating a conjunctival laceration?

Laceration of deeper ocular structures.

What test should be performed when evaluating a conjunctival laceration for deeper injury?

Seidel test to look for corneal perforation.

How should a conjunctival laceration wound be cleaned?

Irrigate with sterile saline to remove particulate matter or clotted blood.

How should a visible foreign body associated with a conjunctival laceration be removed?

By the least invasive means possible.

How are conjunctival lacerations smaller than 10 mm generally managed?

They typically heal within 7 days with prophylactic therapy alone.

What lubrication is recommended for a conjunctival laceration smaller than 10 mm?

Preservative-free artificial tears QID or more frequently.

What prophylactic antibiotic drops may be used for a small conjunctival laceration?

Moxifloxacin 0.5% BID for 4–7 days.

What prophylactic antibiotic ointment may be used for a small conjunctival laceration?

Tobramycin 0.3% TID for 4–7 days.

When may a steroid/antibiotic combination be used for a conjunctival laceration?

When there is significant discomfort and/or inflammation.

What steroid/antibiotic combination regimen is listed for a conjunctival laceration with significant discomfort or inflammation?

Tobradex QID.

How are conjunctival lacerations measuring 10–15 mm managed?

Antibiotic ointment and a pressure patch after appositional placement of the wound edges.

When should a patient with a 10–15 mm conjunctival laceration be reevaluated?

After 24 hours, with treatment repeated as necessary.

How should conjunctival lacerations larger than 15 mm be managed?

Consider surgical repair with suturing or tissue glue by a corneal specialist or ophthalmologist.