Corneal laceration with expulsive iridodialysis and vitreous prolapse following blunt trauma

Aims/Purpose: A full‐thickness corneal laceration can occur following blunt trauma and is an ocular emergency that requires decisive immediate, short and long‐term management. We describe an unusual case of blunt trauma leading to dehiscence of an old cataract wound with traumatic expulsive Iridodialysis associated with vitreous prolapse to create awareness among ophthalmologists on key diagnostic features and patient specific management for this condition. Methods: An 84 year old female presented to the eye emergency department following accidental trauma to her right eye. Ocular examination revealed a 3 mm corneal laceration that was just away from the limbus which was compatible with the incision used for prior cataract surgery over 10 years prior. There was signs of expulsive Iridodialysis as well as vitreous prolapse from this wound with associated ruptured posterior capsule, inferior IOL subluxation and pupil block angle closure. Results: Immediate management included excision of prolapsed vitreous and iris from the corneal laceration, placement of bandage contact lens and an eyeshield, as well as topical and systemic antibiotic therapy, topical steroids and IOP control. Within 3 days, the corneal laceration remained sealed following removal of the bandage contact lens and surgery was performed which included pars plana vitrectomy, IOL repositioning and corneal suturing. Conclusions: We report this case to emphasize the importance of careful anterior segment examination in cases of suspected globe rupture to identify the site of the opening and to always consider old surgical wounds. Once confirmed, no pressure should be placed on the eye to reduce the risk of further extravasation of intraocular contents.