Difference between revisions of "Globe rupture"

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*Keep patient NPO
 
*Keep patient NPO
 
*[[Intubation]], if necessary
 
*[[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>
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**[[Succinylcholine]] and [[ketamine]] <3mg/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==

Revision as of 02:00, 19 July 2016

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 with any puncture or laceration of eyelid or periorbital area
    • More commonly assoc with objects from metal on metal, lawn mower, drills, grinders[1]

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

References

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