The sclera is the tough, white outer layer of the eyeball. A scleral tear, also known as a scleral laceration or ruptured globe, is a serious injury where this protective wall is cut or torn. This is considered an ophthalmological emergency because it compromises the eye’s structural integrity. A breach in the sclera can lead to a loss of intraocular fluid and expose the inside of the eye to infection, posing a significant threat to vision.
Common Causes and Symptoms
Scleral tears are caused by significant trauma to the eye, which is categorized as either penetrating or blunt force. Penetrating injuries result from sharp objects, such as pieces of metal, glass, or thorns, physically piercing the sclera and creating a direct laceration.
Blunt force trauma results from a powerful impact from an object like a fist or a ball. This force can cause a sudden increase in the eye’s internal pressure, leading to a rupture. These ruptures often occur at the sclera’s weakest points, such as near the equator of the eye or at the site of previous eye surgeries.
The symptoms of a scleral tear are usually immediate and severe. A person may experience intense eye pain and a sudden decrease or loss of vision. There might be a visible cut or dark spot on the white part of the eye, and leakage of clear or bloody fluid can occur. The shape of the eye may appear distorted, or the pupil may look peaked or irregularly shaped.
Medical Diagnosis and Surgical Repair
Upon arrival at a hospital, a medical team will perform an examination to diagnose a scleral tear. An ophthalmologist will assess visual acuity and use a slit lamp, a specialized microscope, to inspect the eye. If a rupture is suspected but not visible, a CT scan is often ordered. This imaging helps confirm the injury’s extent and identify any foreign objects or associated damage.
Treatment for a scleral tear is surgical and performed as soon as possible to prevent complications. The primary objective is to close the wound and restore the globe’s structural integrity. Under anesthesia, the surgeon uses microscopic sutures, often made of nylon, to stitch the scleral tissue back together. This re-establishes the closed environment of the eye.
In complex cases, if intraocular tissue, such as the iris or vitreous gel, has prolapsed through the wound, the surgeon may need to reposition or remove it. If there is significant tissue loss making direct closure impossible, a patch graft might be required. The goal is to create a watertight seal to protect the eye from infection and provide a stable foundation for further procedures.
The Recovery Process
The recovery period following scleral tear repair requires careful management. Immediately after surgery, a protective shield will be placed over the eye to guard against accidental pressure or rubbing. Patients are prescribed antibiotic eye drops to prevent infection and anti-inflammatory drops to manage swelling. Regular follow-up appointments are scheduled to monitor the healing process.
Activity restrictions are an important part of the post-operative phase. To avoid putting stress on the healing eye, patients are instructed to avoid strenuous exercise, heavy lifting, and bending over for several weeks. These precautions help prevent an increase in pressure inside the eye that could compromise the surgical repair. Some individuals may need to maintain a specific head position to aid healing.
The ultimate prognosis for vision depends on the severity and location of the initial injury. The outcome is often dictated by whether internal components like the retina, lens, or optic nerve were also damaged. If these structures are significantly harmed, full vision recovery may not be possible. Some patients may require additional surgeries, such as a vitrectomy to clear blood or to repair a detached retina.