PurposeTo describe the use of equine pericardium as an off-label temporary emergency treatment of scleral and corneal perforations. Methods Three eyes of two male patients aged 34 and 38 years were included, i.e. a case with a history of severe bilateral thermal burn undergoing phacoemulsification complicated by tearing of the main port causing iris exposure and a patient with bilateral corneal perforation secondary to non-infectious corneal melt due to presumed ocular non-steroid anti-inflammatory drug abuse. The equine pericardium patch was soaked in balanced salt solution, trimmed and sutured over the perforated area with interrupted nylon 10-0 sutures. Slit-lamp photographs were taken before and immediately after surgery as well as at 2 and 5 months postoperatively. ResultsA watertight closure of the perforation was achieved in both cases. No evidence of infection, severe inflammation, leakage or hypotony was detected throughout the observation period. The first patient developed a pseudopterygium over the pericardium patch 5 months after surgery. The second patient showed at 2 months a bilateral melt of the pericardium and loosening of the sutures. After removal of the latter, a tectonically stable scar was evident in both eyes. Conclusion Equine pericardium offered an effective primary treatment in cases of non-infectious globe perforation and may be considered when other materials, e.g. amniotic membrane, corneal or scleral allografts, are not readily available. Further studies may further elucidate the safety and efficacy profile of this biomaterial in ophthalmic surgery.