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

1. Blunt Eye Trauma
   1. Caused by suddenly elevated IOP
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's sign - do not perform this test if suspect open globe
      1. May be falsely negative if scleral rupture is small
   4. 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

• Orbital Blowout Fracture
• Retrobulbar Hematoma

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

Orbital Blowout Fracture

Source

• Tintinalli
• UpToDate
• Rosen's