A 31-year-old woman presented to the emergency department (ED) after suffering multiple lacerations during an assault. The patient stated it was unclear what weapon the assailant had used, but she thought it was a sharp blade of some kind. She had two linear lacerations on her right arm that were superficial and did not require suturing.
She also had a 3 cm linear laceration over her right eyelid. She denied any pain in the eye or vision changes. On examination, her pupillary response and ocular movements were intact. The ED provider did not formally check her visual acuity but asked her to close each eye separately and asked her if she noted any change in her vision (which she did not). The ED provider everted the lid (turned it up to see underneath) and the laceration did not appear to extend through the eyelid. He performed a fluorescence examination and did not note any corneal abrasion or evidence of injury to the globe. The eyelid laceration was sutured without complication. An ophthalmologist was not consulted.
The patient presented to a different hospital 10 days later complaining of eye pain. At that time, she reported to providers that her vision had been poor in the right eye since the attack. She was referred to an ophthalmologist and found to have a ruptured globe. She was taken to the operating room for repair and found to have a 4 mm cut in the cornea that extended 7 mm into the sclera (globe of the eye). This laceration was directly beneath the laceration in her eyelid. The defects in the cornea and sclera were repaired, but she had some residual pain and mild visual deficits after the procedure.
