Corneal hematoma

S. S. Searl, S. D. Croll, S. A. Boruchoff and D. M. Albert

Two cases of corneal hematomas initially manifested as corneal blood staining, but were further complicated by the presence of persistent epithelial defects and stromal thinning. Both cases occurred following cataract surgery. Scanning electron and light microscopic examination in the second case demonstrated a loss of keratocytes, stromal collagen breakdown, and epithelial cell degeneration over the center of the hematoma. Large corneal hematomas may cause epithelial degeneration by functioning as barriers to nutrients and metabolic factors from the anterior chamber. Unlike corneal blood staining, conservative treatment is often insufficient therapy for corneal hematomas with associated persistent epithelial defects. Complications from epithelial defects, including corneal thinning, descemetocele, and perforation, may necessitate more aggressive treatment, even surgery. An epithelial defect overlying blood staining should suggest the presence of a corneal hematoma.