Surgical management of corneal ulceration and perforation

Corneal ulceration leading to perforation can occur secondary to a number of conditions, including infection, trauma, corneal dryness, and exposure keratitis. Because the ocular morbidity of corneal perforations is high, prompt diagnosis and treatment is critical. When persistent corneal ulceration does not respond to medical treatment, including antibiotics, therapeutic soft contact lenses, or tarsorrhaphy, surgical intervention is indicated. In this review, the evaluation of patients with recalcitrant ulceration or perforation is summarized, and indications and techniques for surgical treatment (epithelial transplantation, conjunctival flaps, lamellar and penetrating keratoplasty, tissue adhesives, periosteal grafts) are described.