Difference between revisions of "Globe rupture"

m (Rossdonaldson1 moved page Globe Rupture to Globe rupture)
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**Evert lids with paperclips or eyelid retractors
 
**Evert lids with paperclips or eyelid retractors
  
==Causes==
+
===Causes===
 
#[[Blunt Eye Trauma]]
 
#[[Blunt Eye Trauma]]
 
##Caused by suddenly elevated IOP
 
##Caused by suddenly elevated IOP
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**Sensitivity ~60%
 
**Sensitivity ~60%
  
==DDx==
+
==Differential Diagnosis==
*[[Orbital Blowout Fracture]]
+
{{Maxillofacial trauma DDX}}
*[[Retrobulbar Hematoma]]
 
*[[Traumatic Hyphema]]
 
  
==Treatment==
+
==Management==
 
*Consult ophtho immediately
 
*Consult ophtho immediately
 
*Do not manipulate the eye  
 
*Do not manipulate the eye  
 
*Eye covering with metal shield or paper cup
 
*Eye covering with metal shield or paper cup
 
*Elevate head of bed
 
*Elevate head of bed
*Treat nausea/vomiting
+
*Treat [[nausea/vomiting]]
*Broad spectrum IV ABX
+
*Broad spectrum IV [[antibiotics]]
**Ceftazidime 1gm + vanco 1 gm
+
**[[Ceftazidime]] 1gm + [[vanco]] 1 gm
**PCN allergy: Cipro + vanco
+
**[[PCN allergy]]: [[Cipro]] + [[vanco]]
*Tetanus, if indicated
+
*[[Tetanus]], if indicated
 
*Keep patient NPO
 
*Keep patient NPO
*If intubation necessary, recent studies show succinylcholine and ketamine <3 mg/kg do not increase intraocular pressure or cause adverse outcomes<ref>Libonati MM, Leahy JJ, Ellison N: The use of succinylcholine in open eye surgery. Anesthesiology 1985; 62:637-640</ref>
+
*[[Intubation]], if necessary
 +
**[[Succinylcholine]] and [[ketamine]] <3 mg/kg do not increase intraocular pressure or cause adverse outcomes<ref>Libonati MM, Leahy JJ, Ellison N: The use of succinylcholine in open eye surgery. Anesthesiology 1985; 62:637-640</ref>
  
 
==Disposition==
 
==Disposition==
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==See Also==
 
==See Also==
[[Orbital Blowout Fracture]]
+
*[[Orbital Blowout Fracture]]
  
 
==Source==
 
==Source==

Revision as of 17:47, 10 January 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

  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%

Differential Diagnosis

Maxillofacial Trauma

Management

Disposition

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

See Also

Source

  1. Libonati MM, Leahy JJ, Ellison N: The use of succinylcholine in open eye surgery. Anesthesiology 1985; 62:637-640