Overview
Adenoviral keratitis is an ocular surface disease that can lead to corneal perforations, particularly in the context of dry eye disease 1. Management is complicated by factors such as an unstable tear film, ocular surface inflammation, and potential systemic conditions affecting wound healing 1.Diagnosis
Careful preoperative examination is required to identify underlying pathology, assess the ocular surface and adnexa, and rule out microbial keratitis 1.
Systemic workup may be indicated 1.
Assessment of the perforation itself is crucial 1.Management
Surgical options for corneal perforations include tissue adhesives, multilayered amniotic membrane grafting (AMT), tenon patch graft (TPG), corneal patch graft (CPG), and penetrating keratoplasty (PK) 1.
The choice of procedure depends on the size, location, and configuration of the perforation 1.
Tissue adhesives are effective for smaller perforations 1.
AMT, TPG, and CPG are viable options for moderate-sized perforations 1.
AMT and TPG are preferable when a bandage contact lens placement is challenging 1.
Large perforations require PK, potentially with additional procedures like tarsorrhaphy 1.
Conjunctival flaps are considered for eyes with poor visual potential 1.
Management of the acute condition should be combined with measures to improve tear volume, considering the risk of delayed epithelialization and re-perforation 1.Key Recommendations
For smaller corneal perforations, tissue adhesives are an effective treatment modality 1. (Evidence: Expert opinion)
For moderate-sized perforations, amniotic membrane grafting (AMT), tenon patch graft (TPG), and corneal patch graft (CPG) are viable options 1. (Evidence: Expert opinion)
Large corneal perforations typically require penetrating keratoplasty (PK) 1. (Evidence: Expert opinion)References
1 Kate A, Deshmukh R, Donthineni PR, Sharma N, Vajpayee RB, Basu S. Management of corneal perforations in dry eye disease: Preferred practice pattern guidelines. Indian journal of ophthalmology 2023. link