When Less Is More: The Less Invasive Approach For A Very Good Clinical Outcome

To report the clinical presentation and the management of a full-thickness corneal lesion in a young boy. 

Eye Clinic, DiNOGMI, University of Genoa and IRCCS San Martino Polyclinic Hospital, Genoa, Italy. 

Clinical and imaging description of a clinical case. Slit-lamp examination, anterior segment optical coherence tomography (AS-OCT), and anterior segment photography were performed during the first examination and at each follow-up visit.

A 14-year-old boy complained about a feeling of grittiness in his left eye. Biomicroscopy revealed a thorn size vertically oriented central corneal lesion. The Seidel test was positive, although the anterior chamber was deep. He revealed a recent trauma with a tree thorn. A more accurate evaluation was performed with an anterior segment optical coherence tomography (AS-OCT), and a full-thickness perforation was found. Therapeutic contact lens and Chloramphenicol, 0.5% eyedrops 2 hourly for the first 48 hours, alternating on the half-hour with Fluconazole, was started. The Seidel test improved in the following days, although the complete corneal wound closure at the AS-OCT was achieved at three months, with a visual acuity of 20/20.

Prompt management of corneal lesion with antibiotics and antifungal agents is mandatory to prevent corneal infection. Thorns and tree branches are the most common predisposing factor on the fungal keratitis spectrum. The detailed front-to-back layered cornea structure provided by AS-OCT allowed accurate monitoring of the healing process. This non-invasive approach has proven to be a good option for avoiding suture-induced astigmatism and ensuring good visual acuity in the management of a slim but full-thickness central cornea lesion caused by a tree thorn.