Management Of Corneal Perforation With Cyanoacrylate Glue

Corneal perforation, a potentially devastating complication, can result from numerous conditions that precipitate corneal melting. Numerous causes include microbial keratitis, ocular surface disease, and autoimmune disorders. It is associated with significant ocular morbidity and warrants prompt intervention, both to restore globe integrity and to minimize the risk of secondary complications. Various management options have been described in the literature, with multi-staged procedures that are often required to facilitate visual rehabilitation.we present a case of  management of a corneal perforation with Cyanoacrylate glue.

This 33-year-old patient had been hospitalized in the dermatology department for Stevens Johnson syndrome for 2 weeks and was referred to the ophthalmology emergency department because of a painful red eye with decreased visual acuity in the right eye.

Ophthalmological examination revealed: conjunctival hyperhemia; perihematic ring; presence of symblepharons inferiorly; severe dry eye; central punctiform thinning of the cornea surrounded by peri-lesional edema; no infiltrates or secretions; good depth and calmness of the anterior chamber; clear lens; the rest of the clinical examination was unremarkable.The patient was rushed to the operating room, where Cyanoacrylate glue was applied to the corneal thinning, and antibiotic eye drops, artificial tears and healing ointment were prescribed, along with an antisymblépharon ring.The evolution was marked by stabilization of the corneal lesion; and then after follow-up of the patient with administration of ciclosporin eye drops.

The causes of corneal perforation can be classified as either traumatic or nontraumatic, with nontraumatic perforation being further divided into infectious or noninfectious causes.Noninfectious etiologies include ocular surface or autoimmune disease.

Cyanoacrylates are ester derivatives of cyanoacrylic acid.This method is best suited to perforations that measure less than 3 mm in diameter are concave in profile and located away from the limbus.

The management of a corneal perforation depends on the size shape location and cause of the lesion.Smaller lesions may be managed with tissue adhesives.Tenon's patch grafting or amniotic membrane transplantation.Larger perforations may need urgent keratoplasty. 

The management of corneal perforation relies on several techniques depending on size and location; must be known by the ophthalmologist who must intern urgently to avoid complications, especially infectious ones