An 83-year-old man with advanced Alzheimer's disease, insulin-dependent diabetic of 35 years' duration, who attended our emergency department for ocular pain in the right eye of 2 days' duration.
VA could not be measured due to lack of cooperation. Evaluation of the anterior segment revealed a corneal ulcerative lesion 2.5mm in diameter with a central perforating endothelial pore of approximately 1mm, with no concomitant infectious or inflammatory process. The patient had no history of trauma.
With the diagnosis of a sterile non-traumatic corneal perforation, the lesion was urgently closed.
Under topical anaesthesia and in the operating theatre to facilitate collaboration, a Tachosil® patch was prepared and cut in such a way that it went beyond the edges of the ulceration for complete coverage. After hydration with saline for 5 seconds, the active part (yellow part) was immediately applied to the corneal defect, pressing and gently moulding the sponge for 3 minutes with forceps to ensure that it was firmly attached to the lesion.

Without removing the excess material, the eye was occluded. On uncovering, after about 36 hours of occlusion, it was observed that there were no sponge remnants in the area of application and a fibrinoid material occluded the perforating endothelial pore. No sponge debris was found to be displaced or in the conjunctival fornices. A therapeutic lens was applied for safety and topical antibiotic, cycloplegic and medroxyprogesterone treatment was started. Seventy-two hours after application, corneal thinning persisted over the perforation area, with complete closure and good anterior chamber depth. Subsequent controls at one week and one month confirmed total corneal closure and the therapeutic lens and the medical treatment described could be removed.