Globe rupture
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
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%
DDx
Treatment
- Consult ophtho immediately
- Do not manipulate the eye
- No eye drops
- Eye covering with metal shield or paper cup
- Elevate head of bed
- Treat nausea/vomiting
- Broad spectrum IV ABX
- Ceftazidime 1gm + vanco 1 gm
- PCN allergy: Cipro + vanco
- Tetanus, if indicated
- Keep patient NPO
- If intubation necessary, recent studies show succinylcholine and ketamine <3 mg/kg are ok.
Disposition
- Admission for surgical repair by ophthalmology
- Transfer to tertiary trauma center if ophthalmologist prefer
See Also
Source
- Tintinalli
- UpToDate
- Rosen's