Globe rupture: Difference between revisions
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% | ||
== | ==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
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
- Ears
- Nose
- Oral
- Other face
- Zygomatic arch fracture
- Zygomaticomaxillary (tripod) fracture
- Related
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