Difference between revisions of "Globe rupture"
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(→ManagementLayer N, et a. Algorithm for evaluation and management of the ruptured globe in an adult. Department of Ophthamology, University of California, San Francisco. http://www.icoph.org/dynamic/attachments/resources/rupturedglobeico.pdf) |
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==Management<ref>Layer N, et a. Algorithm for evaluation and management of the ruptured globe in an adult. Department of Ophthamology, University of California, San Francisco. http://www.icoph.org/dynamic/attachments/resources/rupturedglobeico.pdf</ref>== | ==Management<ref>Layer N, et a. Algorithm for evaluation and management of the ruptured globe in an adult. Department of Ophthamology, University of California, San Francisco. http://www.icoph.org/dynamic/attachments/resources/rupturedglobeico.pdf</ref>== | ||
*Consult ophtho immediately | *Consult ophtho immediately | ||
− | *Do not manipulate the eye | + | **Keep NPO |
− | *Eye covering with metal shield or paper cup | + | *Prevent further injury |
− | *Elevate head of bed | + | **Do not manipulate the eye |
− | * | + | **Eye covering with metal shield (Fox shield) or paper cup (do not place a patch that touches globe) |
− | + | *Minimize elevations in intraocular pressure | |
− | **[[ | + | **Elevate head of bed |
− | * | + | **bed rest; no bending/lifting/Valsalva |
− | *[[Tetanus]] | + | **Consider anti-emetic (e.g. [[ondansterone]] 4mg IV) |
− | * | + | *IV pain medications PRN |
− | + | *[[Tetanus prophylaxis]] (if indicated) | |
− | + | *If [[intubation]] necessary, use [[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> | |
+ | |||
+ | ===[[Antibiotics]]<ref>Layer N, et a. Algorithm for evaluation and management of the ruptured globe in an adult. Department of Ophthamology, University of California, San Francisco. http://www.icoph.org/dynamic/attachments/resources/rupturedglobeico.pdf</ref>=== | ||
+ | ====NO intra-ocular foreign body==== | ||
+ | *First choice: [[Fluoroquinolone]] IV, '''OR''' | ||
+ | *Second choice: [[Vancomycin]] IV and [[cetazidime]] | ||
+ | |||
+ | ====Intra-ocular foreign body PRESENT==== | ||
+ | *[[Ceftazidime]] 1gm + [[vancomycin]] 1 gm | ||
+ | *[[penicillin allergy]]: [[Cipro]] + [[vanco]] | ||
==Disposition== | ==Disposition== |
Revision as of 20:28, 17 December 2017
Contents
Background
- Vision threatening emergency
- Is a full thickness disruption of sclera or cornea[1]
- 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 associated with objects from metal on metal, lawn mower, drills, grinders[2]
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
- 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
Evaluation
- 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[3]
- Consult ophtho immediately
- Keep NPO
- Prevent further injury
- Do not manipulate the eye
- Eye covering with metal shield (Fox shield) or paper cup (do not place a patch that touches globe)
- Minimize elevations in intraocular pressure
- Elevate head of bed
- bed rest; no bending/lifting/Valsalva
- Consider anti-emetic (e.g. ondansterone 4mg IV)
- IV pain medications PRN
- Tetanus prophylaxis (if indicated)
- If intubation necessary, use succinylcholine and ketamine <3mg/kg (do not increase intraocular pressure or cause adverse outcomes)[4]
Antibiotics[5]
NO intra-ocular foreign body
- First choice: Fluoroquinolone IV, OR
- Second choice: Vancomycin IV and cetazidime
Intra-ocular foreign body PRESENT
- Ceftazidime 1gm + vancomycin 1 gm
- penicillin allergy: Cipro + vanco
Disposition
- Admission for surgical repair by ophthalmology
- Transfer to tertiary trauma center if ophthalmologist prefer
See Also
References
- ↑ Layer N, et a. Algorithm for evaluation and management of the ruptured globe in an adult. Department of Ophthamology, University of California, San Francisco. http://www.icoph.org/dynamic/attachments/resources/rupturedglobeico.pdf
- ↑ 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
- ↑ Layer N, et a. Algorithm for evaluation and management of the ruptured globe in an adult. Department of Ophthamology, University of California, San Francisco. http://www.icoph.org/dynamic/attachments/resources/rupturedglobeico.pdf
- ↑ Libonati MM, Leahy JJ, Ellison N: The use of succinylcholine in open eye surgery. Anesthesiology 1985; 62:637-640
- ↑ Layer N, et a. Algorithm for evaluation and management of the ruptured globe in an adult. Department of Ophthamology, University of California, San Francisco. http://www.icoph.org/dynamic/attachments/resources/rupturedglobeico.pdf