Glues in Ophthalmology

Types of Ophthalmic Glue

• Cyanoacrylate tissue adhesive is not FDA-approved for ocular use but is widely used off-label in the management of corneal ulceration and perforation - Goodman & Gilman's The Pharmacological Basis of Therapeutics, p. 1061 (block20).
• On contact with moisture (tears), it polymerizes rapidly into a hard, rough plug that mechanically seals the defect and also has some antibacterial (mainly gram-positive) effect.

• A biological, two-component sealant (fibrinogen + thrombin, e.g., TISSEEL) that mimics the final step of the coagulation cascade to form a fibrin clot securing tissue.
• Fibrin sealants are increasingly used on the ocular surface to secure tissue such as conjunctiva, amniotic membrane, and lamellar corneal grafts - Goodman & Gilman's, p. 1063.

Clinical Indications

• Used for small perforations, typically less than 1-2 mm; larger perforations need surgical correction (patch graft or keratoplasty) - The Wills Eye Manual, p. (block1, lines 7751-7762).
• Technique: the glue is applied to one side of a small trimmed patch of sterile plastic drape after drying the wound edges with a cellulose sponge; the patch is pressed over the defect, and a bandage contact lens is placed over it for comfort and to aid retention - Kanski's Clinical Ophthalmology, 10th ed., p. 216.
• Also used in impending/actual perforation from infectious or sterile (neurotrophic, autoimmune) corneal melts, and in stromal keratitis with perforation risk - Wills Eye Manual (multiple sections on microbial keratitis, HSV stromal keratitis).

• Occasionally used for small post-trabeculectomy or post-cataract wound leaks, combined with a bandage contact lens and aqueous suppressants to reduce flow through the wound - Wills Eye Manual, "Wound Leak" section.
• Also used for cyclodialysis cleft/hypotony maculopathy management alongside sutures or bandage lens - Wills Eye Manual, p. (block3, lines 2040-2050).

• After conjunctival autografting, the donor conjunctival patch can be secured with fibrin glue (e.g., TISSEEL) instead of 10-0 nylon sutures, which shortens operating time and reduces postoperative irritation/foreign body sensation - Kanski's Clinical Ophthalmology, 10th ed., p. 216.

• Securing amniotic membrane grafts for persistent epithelial defects.
• Fixing lamellar corneal grafts (e.g., in lamellar keratoplasty, DALK/DSEK-type procedures) - Goodman & Gilman's, p. 1063.

Quick Comparison Table

Exam Points to Remember

• Cyanoacrylate = mechanical/chemical seal for perforations (cornea, wound leaks); size cutoff commonly quoted is <1-2 mm.
• Fibrin glue = tissue fixation without sutures, classic association is pterygium conjunctival autograft, also amniotic membrane and lamellar graft fixation.
• Both are adjuncts, not substitutes, for definitive surgical repair (patch graft/keratoplasty) when the perforation is large or the process (infection/melt) is not controlled.