Difference between revisions of "Globe rupture"

(Background)
(Background)
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==Background==
 
==Background==
 
*Vision threatening emergency
 
*Vision threatening emergency
*Is a full thickness disruption of sclera or cornea
+
*Is a full thickness disruption of sclera or cornea<ref>Layer N, et a. Algorithm for evaluation and management of the ruptured globe in an adult. Department of Ophthamology, University of California, San Francisco. http://www.icoph.org/dynamic/attachments/resources/rupturedglobeico.pdf</ref>
 
*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

Revision as of 20:08, 17 December 2017

Background

  • Vision threatening emergency
  • Is a full thickness disruption of sclera or cornea[1]
  • 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 with any puncture or laceration of eyelid or periorbital area
    • More commonly associated with objects from metal on metal, lawn mower, drills, grinders[2]

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

Evaluation

  • 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[3]

Disposition

  • Admission for surgical repair by ophthalmology
  • Transfer to tertiary trauma center if ophthalmologist prefer

See Also

References

  1. Layer N, et a. Algorithm for evaluation and management of the ruptured globe in an adult. Department of Ophthamology, University of California, San Francisco. http://www.icoph.org/dynamic/attachments/resources/rupturedglobeico.pdf
  2. Zhang Y et al. Intraocular foreign bodies in China: clinical characteristics, prognostic factors and visual outcomes in 1421 eyes. Am J Ohthalmol. 2011:152:66-73
  3. Layer N, et a. Algorithm for evaluation and management of the ruptured globe in an adult. Department of Ophthamology, University of California, San Francisco. http://www.icoph.org/dynamic/attachments/resources/rupturedglobeico.pdf
  4. Libonati MM, Leahy JJ, Ellison N: The use of succinylcholine in open eye surgery. Anesthesiology 1985; 62:637-640