Globe rupture: Difference between revisions
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===Causes=== | ===Causes=== | ||
*[[Blunt Eye Trauma]] | |||
**Caused by suddenly elevated IOP | |||
*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== | ==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's sign - do not perform this test if suspect open globe | |||
***May be falsely negative if scleral rupture is small | |||
**Lens dislocation | |||
==Differential Diagnosis== | |||
{{Maxillofacial trauma DDX}} | |||
==Diagnosis== | ==Diagnosis== | ||
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*Do NOT perform tonometry for IOP | *Do NOT perform tonometry for IOP | ||
==Work-Up== | ===Work-Up=== | ||
*Non-contrast CT orbit | *Non-contrast CT orbit | ||
**Consider if concern for intraocular foreign body OR diagnosis is unclear | **Consider if concern for intraocular foreign body OR diagnosis is unclear | ||
**Sensitivity ~60% | **Sensitivity ~60% | ||
==Management== | ==Management== |
Revision as of 13:32, 24 May 2015
Background
- Vision threatening emergency
- Rupture of the sclera of the eye
- Be careful not to apply pressure to eye
- Evert lids with paperclips or eyelid retractors
Causes
- Blunt Eye Trauma
- Caused by suddenly elevated IOP
- 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's sign - do not perform this test if suspect open globe
- May be falsely negative if scleral rupture is small
- Lens dislocation
Differential Diagnosis
Maxillofacial Trauma
- Ears
- Nose
- Oral
- Other face
- Zygomatic arch fracture
- Zygomaticomaxillary (tripod) fracture
- Related
Diagnosis
- Inspect lids, lashes, cornea, sclera, and pupils.
- Evaluate for a relative afferent pupillary defect
- Visual Acuity
- Do NOT perform tonometry for IOP
Work-Up
- Non-contrast CT orbit
- Consider if concern for intraocular foreign body OR diagnosis is unclear
- Sensitivity ~60%
Management
- Consult ophtho immediately
- Do not manipulate the eye
- Eye covering with metal shield or paper cup
- Elevate head of bed
- Treat nausea/vomiting
- Broad spectrum IV antibiotics
- Ceftazidime 1gm + vanco 1 gm
- PCN allergy: Cipro + vanco
- Tetanus, if indicated
- Keep patient NPO
- Intubation, if necessary
- Succinylcholine and ketamine <3 mg/kg do not increase intraocular pressure or cause adverse outcomes[1]
Disposition
- Admission for surgical repair by ophthalmology
- Transfer to tertiary trauma center if ophthalmologist prefer
See Also
Source
- ↑ Libonati MM, Leahy JJ, Ellison N: The use of succinylcholine in open eye surgery. Anesthesiology 1985; 62:637-640