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    Expert tips for surgically managing corneal perforations


    Pinpoint perforations may seal spontaneously under a tamponade. Aqueous suppressants can help. “A lot of people use glaucoma medications to reduce the pressure, allowing the hole to close,” Dr. Tuli said.

    An off-the-shelf extended-wear contact lens works best as a tamponade, Dr. Tuli said. She doesn’t use pressure patches because they make the eye more warm and humid. With pressure patches, it is not possible to see whether the hole is healing, and the patient cannot give any information about how vision is affected.

    Sometimes, the iris prolapses through the perforation. If the clinician encounters this phenomenon within 24 hours of the injury, it may be possible to reposition the iris, tamponade the perforation with an air bubble, and apply glue.

    If the iris has prolapsed for a longer period of time, repositioning the iris raises the risk of dragging infection or epithelial cells from the surface deeper into the eye. If fluid is leaking from around the iris, Dr. Tuli recommends applying glue and a plastic drape circle.

    If there is no leakage, there is usually a fibrin layer overlying the iris, and it may heal without intervention.

    When does it need a specialist?

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