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    Expert tips for surgically managing corneal perforations

    One of the most memorable patients ever to walk into the office of Sonal Tuli, MD, had a fishhook protruding from his eye, which he held open with his fingers.

    It is the kind of injury that gives even seasoned ophthalmologists pause. “People don’t want to deal with it,” Dr. Tuli said. “They don’t have the training, and it scares them.”

    In her talk at the 2015 American Academy of Ophthalmology meeting, Dr. Tuli, who specializes in management of perforated corneal ulcers at the University of Florida in Gainesville, Florida, offered tips for plugging the holes. “We see a lot of it here,” she said.

    Unlike lacerations, perforations often involve tissue loss, complicating the treatment, she said. The cornea does not have a blood supply, so it does not heal as rapidly as other tissues.

    “What I’m talking about is a hole in the eye,” she said. “Now you have aqueous leaking out and infection tracking back in. It’s potentially eye-threatening.” Gluing, grafting, or a corneal transplant can usually save the eye, she said.

    Understanding the mechanism of an injury can provide some guidance about treating it. A variety of unfortunate events can cause perforations, she said. In addition to fish hooks, projectiles can also make holes. Sometimes, physicians cause them in the process of trying to remove a foreign body or in the course of refractive surgery.

    More often, keratitis causes the ulcers when fungi or bacteria, particularly Pseudomonas, invade the tissue. “Usually bacteria can’t do it by themselves unless there’s some trauma, even though it’s minor,” Dr. Tuli said. “It could be rubbing your eye really hard.”

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