Difference between revisions of "Globe rupture"

Line 1: Line 1:
 
==Background==
 
==Background==
 
*Vision threatening emergency
 
*Vision threatening emergency
 +
*Rupture of the sclera of the eye
 
*Be careful not to apply pressure to eye
 
*Be careful not to apply pressure to eye
 
**Evert lids with paperclips or eyelid retractors
 
**Evert lids with paperclips or eyelid retractors
  
 
==Causes==
 
==Causes==
#Blunt trauma
+
#[[Blunt Eye Trauma]]
##IOP rises w/ scleral rupture at thinnest points (limbus, insertion of EOM)
+
##Caused by suddenly elevated IOP
 
#Penetrating trauma
 
#Penetrating trauma
 
##Suspect globe penetration w/ any puncture or laceration of eyelid or periorbital area
 
##Suspect globe penetration w/ any puncture or laceration of eyelid or periorbital area
Line 21: Line 22:
 
##Shallow anterior chamber
 
##Shallow anterior chamber
 
##Hyphema
 
##Hyphema
##Seidel
+
##Seidel's sign - do not perform this test if suspect open globe
 
###May be falsely negative if scleral rupture is small
 
###May be falsely negative if scleral rupture is small
 
##Lens dislocation
 
##Lens dislocation
  
 
==Diagnosis==
 
==Diagnosis==
#CT orbit
+
*Inspect lids, lashes, cornea, sclera, and pupils.
##Consider if concern for intraocular foreign body OR diagnosis is unclear
+
*Evaluate for a relative afferent pupillary defect
##Sensitivity ~60%
+
*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==
 
==Treatment==
*Consult ophtho immediately  
+
*Consult ophtho immediately
 +
*Do not manipulate the eye
 +
**No eye drops
 
*Eye covering with metal shield or paper cup
 
*Eye covering with metal shield or paper cup
 
*Elevate head of bed
 
*Elevate head of bed
*Prevent nausea/vomiting
+
*Treat nausea/vomiting
*Abx
+
*Broad spectrum IV ABX
 
**Ceftazidime 1gm + vanco 1 gm
 
**Ceftazidime 1gm + vanco 1 gm
 
**PCN allergy: Cipro + vanco
 
**PCN allergy: Cipro + vanco
*Tetanus
+
*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==
 
==See Also==
Line 45: Line 64:
 
==Source==
 
==Source==
 
*Tintinalli
 
*Tintinalli
 +
*UpToDate
 +
*Rosen's
  
 
[[Category:Ophtho]]
 
[[Category:Ophtho]]

Revision as of 20:36, 12 September 2013

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

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