Difference between revisions of "Globe rupture"

Line 6: Line 6:
  
 
===Causes===
 
===Causes===
#[[Blunt Eye Trauma]]
+
*[[Blunt Eye Trauma]]
##Caused by suddenly elevated IOP
+
**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
##More commonly assoc w/ objects from metal on metal, lawn mower, drills, grinders
+
**More commonly assoc w/ objects from metal on metal, lawn mower, drills, grinders
  
 
==Clinical Features==
 
==Clinical Features==
#Eye pain
+
*Eye pain
#+/- decreased visual acuity
+
*+/- decreased visual acuity
#Tear-shaped pupil
+
*Tear-shaped pupil
#Extrusion of intraocular content  
+
*Extrusion of intraocular content  
#Subconjunctival hemorrhage involving entire sclera
+
*Subconjunctival hemorrhage involving entire sclera
#Hemorrhagic chemosis
+
*Hemorrhagic chemosis
#Slit-lamp
+
*Slit-lamp
##Shallow anterior chamber
+
**Shallow anterior chamber
##Hyphema
+
**Hyphema
##Seidel's sign - do not perform this test if suspect open globe
+
**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
 +
 
 +
==Differential Diagnosis==
 +
{{Maxillofacial trauma DDX}}
  
 
==Diagnosis==
 
==Diagnosis==
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*Do NOT perform tonometry for IOP
 
*Do NOT perform tonometry for IOP
  
==Work-Up==
+
===Work-Up===
 
*Non-contrast CT orbit
 
*Non-contrast CT orbit
 
**Consider if concern for intraocular foreign body OR diagnosis is unclear
 
**Consider if concern for intraocular foreign body OR diagnosis is unclear
 
**Sensitivity ~60%
 
**Sensitivity ~60%
 
==Differential Diagnosis==
 
{{Maxillofacial trauma DDX}}
 
  
 
==Management==
 
==Management==

Revision as of 13:32, 24 May 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

  • 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

Differential Diagnosis

Maxillofacial Trauma

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%

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