Globe rupture: Difference between revisions
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==Background== | ==Background== | ||
Be careful not to apply pressure to eye | *Vision threatening emergency | ||
*Be careful not to apply pressure to eye | |||
**Evert lids with paperclips or eyelid retractors | |||
==Causes== | |||
#Blunt trauma | |||
##IOP rises w/ scleral rupture at thinnest points (limbus, insertion of EOM) | |||
#Penetrating trauma | |||
##Suspect globe penetration w/ any puncture or laceration of eyelid or periorbital area | |||
##More commonly assoc w/ objects from metal on metal, lawn mower, drills, grinders | |||
==Clinical Features== | |||
#Eye pain | |||
#+/- decreased visual acuity | |||
#Tear-shaped pupil | |||
#Extrusion of intraocular content | |||
#Subconjunctival hemorrhage involving entire sclera | |||
#Hemorrhagic chemosis | |||
#Slit-lamp | |||
##Shallow anterior chamber | |||
##Hyphema | |||
##Seidel | |||
###May be falsely negative if scleral rupture is small | |||
##Lens dislocation | |||
==Diagnosis== | ==Diagnosis== | ||
#CT orbit | |||
##Consider if concern for intraocular foreign body OR diagnosis is unclear | |||
##Sensitivity ~60% | |||
==Treatment== | ==Treatment== | ||
*Eye covering | *Consult ophtho immediately | ||
*Eye covering with metal shield or paper cup | |||
*Elevate head of bed | *Elevate head of bed | ||
*Prevent nausea/vomiting | *Prevent nausea/vomiting | ||
* | *Abx | ||
** | **Ceftazidime 1gm + vanco 1 gm | ||
**PCN allergy: Cipro + | **PCN allergy: Cipro + vanco | ||
* | *Tetanus | ||
==See Also== | ==See Also== | ||
| Line 19: | Line 44: | ||
==Source== | ==Source== | ||
*Tintinalli | |||
[[Category:Ophtho]] | [[Category:Ophtho]] | ||
Revision as of 00:05, 27 October 2011
Background
- Vision threatening emergency
- Be careful not to apply pressure to eye
- Evert lids with paperclips or eyelid retractors
Causes
- Blunt trauma
- IOP rises w/ scleral rupture at thinnest points (limbus, insertion of EOM)
- Penetrating trauma
- Suspect globe penetration w/ any puncture or laceration of eyelid or periorbital area
- More commonly assoc w/ objects from metal on metal, lawn mower, drills, grinders
Clinical Features
- Eye pain
- +/- decreased visual acuity
- Tear-shaped pupil
- Extrusion of intraocular content
- Subconjunctival hemorrhage involving entire sclera
- Hemorrhagic chemosis
- Slit-lamp
- Shallow anterior chamber
- Hyphema
- Seidel
- May be falsely negative if scleral rupture is small
- Lens dislocation
Diagnosis
- CT orbit
- Consider if concern for intraocular foreign body OR diagnosis is unclear
- 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
Source
- Tintinalli