important that sutures not grasp deep tissue within the eyelid because this may result in cicatricial eversion of the eyelid margins Table 114.3 summarizes those findings that, when associated with eyelid lacerations, should prompt ophthalmology consultation for wound closure CT scan should be considered in all cases of full-thickness perforation of the upper lid because of the possibility of intracranial involvement or occult foreign bodies within the orbital space Pneumocephalus should prompt neurosurgical evaluation A perforating implement can reach the orbital apex and optic nerve Thus, evaluation of visual acuity, relative afferent pupillary defects, and confrontation visual fields can detect signs associated with optic nerve injury in relatively innocuous appearing lacerations CORNEAL AND CONJUNCTIVAL INJURY CLINICAL PEARLS AND PITFALLS Topical anesthetics will only improve pain if the pathology is corneal or conjunctival, and therefore are diagnostically useful If fluorescein staining shows one or more vertical linear abrasions, consider the presence of a foreign body An ophthalmologist should evaluate larger corneal abrasions and those involving the pupillary axis within 24 hours of injury If a teardrop or irregular pupil is seen, the abrasion may represent penetration into the deeper corneal tissues (open-globe injury) and emergent ophthalmology consultation is indicated Corneal abrasions should heal within 48 hours; nonhealing and/or persistently painful abrasions should prompt ophthalmology consultation Current Evidence Literature has established that the use of a patch with simple corneal abrasions does not improve healing or pain control and is therefore generally not recommended Topical antibiotic ointments are frequently prescribed although there is limited data that this practice improves outcome Goals of Treatment The goals of ED treatment of corneal and conjunctival abrasions are as follows: (1) Rule out the presence of more severe ocular injury, (2) control pain, and (3)