Globe rupture

Background

• Vision threatening emergency
• Be careful not to apply pressure to eye
  • Evert lids with paperclips or eyelid retractors

Causes

1. Blunt trauma
   1. IOP rises w/ scleral rupture at thinnest points (limbus, insertion of EOM)
2. Penetrating trauma
   1. Suspect globe penetration w/ any puncture or laceration of eyelid or periorbital area
   2. More commonly assoc w/ objects from metal on metal, lawn mower, drills, grinders

Clinical Features

1. Eye pain
2. +/- decreased visual acuity
3. Tear-shaped pupil
4. Extrusion of intraocular content
5. Subconjunctival hemorrhage involving entire sclera
6. Hemorrhagic chemosis
7. Slit-lamp
   1. Shallow anterior chamber
   2. Hyphema
   3. Seidel
      1. May be falsely negative if scleral rupture is small
   4. Lens dislocation

Diagnosis

1. CT orbit
   1. Consider if concern for intraocular foreign body OR diagnosis is unclear
   2. Sensitivity ~60%

Treatment

• Consult ophtho immediately
• Eye covering with metal shield or paper cup
• Elevate head of bed
• Prevent nausea/vomiting
• Abx
  • Ceftazidime 1gm + vanco 1 gm
  • PCN allergy: Cipro + vanco
• Tetanus

See Also

Orbital Blowout Fracture

Source

• Tintinalli