Difference between revisions of "Globe rupture"
m (Rossdonaldson1 moved page Globe Rupture to Globe rupture) |
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| Line 5: | Line 5: | ||
**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 | ||
| Line 37: | Line 37: | ||
**Sensitivity ~60% | **Sensitivity ~60% | ||
| − | == | + | ==Differential Diagnosis== |
| − | + | {{Maxillofacial trauma DDX}} | |
| − | |||
| − | |||
| − | == | + | ==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 | + | *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 | ||
| − | * | + | *[[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== | ||
| Line 60: | Line 59: | ||
==See Also== | ==See Also== | ||
| − | [[Orbital Blowout Fracture]] | + | *[[Orbital Blowout Fracture]] |
==Source== | ==Source== | ||
Revision as of 17:47, 10 January 2015
Contents
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
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
- Auricular hematoma
- Dental trauma
- Head trauma (main)
- Le Fort fractures
- Mandible fracture
- Nasal fracture
- Nasal septal hematoma
- Orbital trauma
- Skull fracture
- Zygomatic arch fracture
- Zygomaticomaxillary (tripod) fracture
Management
- Consult ophtho immediately
- Do not manipulate the eye
- Eye covering with metal shield or paper cup
- Elevate head of bed
- Treat nausea/vomiting
- Broad spectrum IV antibiotics
- Ceftazidime 1gm + vanco 1 gm
- PCN allergy: Cipro + vanco
- Tetanus, if indicated
- Keep patient NPO
- Intubation, if necessary
- Succinylcholine and ketamine <3 mg/kg do not increase intraocular pressure or cause adverse outcomes[1]
Disposition
- Admission for surgical repair by ophthalmology
- Transfer to tertiary trauma center if ophthalmologist prefer
See Also
Source
- ↑ Libonati MM, Leahy JJ, Ellison N: The use of succinylcholine in open eye surgery. Anesthesiology 1985; 62:637-640