Elderly Male with a Painful Red Eye.

CASE PRESENTATION: An 83-year-old man with a history of left corneal transplant presented to the emergency department with several days of left eye pain, redness, and tearing. Visual acuity was 20/50 in the right eye and bare light perception in the left eye. Intraocular pressure was 15 millimeters fo mercury in the right eye and unobtainable in the left. The left conjunctiva and sclera were injected, and slit-lamp examination revealed a full-thickness corneal perforation with corneal haze in the transplanted cornea. We placed a rigid eye shield, provided systemic analgesia, kept the patient nil per os, and obtained urgent ophthalmology consultation.

DISCUSSION: Corneal perforation is a full-thickness corneal defect that disrupts globe integrity and allows aqueous leakage. It may result from infection, ocular surface disease, autoimmune disorders, trauma, or prior keratoplasty, with graft-host junction instability representing a key risk factor. Diagnosis is clinical, based on visible perforation, a positive Seidel test, or anterior chamber shallowing.