Globe rupture: Difference between revisions
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*Broad spectrum IV [[antibiotics]] | *Broad spectrum IV [[antibiotics]] | ||
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**[[ | **[[penicillin allergy]]: [[Cipro]] + [[vanco]] | ||
*[[Tetanus]], if indicated | *[[Tetanus]], if indicated | ||
*Keep patient NPO | *Keep patient NPO | ||
Revision as of 11:03, 8 September 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 associated 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
- Ears
- Nose
- Oral
- Other face
- Zygomatic arch fracture
- Zygomaticomaxillary (tripod) fracture
- Related
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
- 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
- penicillin allergy: Cipro + vanco
- Tetanus, if indicated
- Keep patient NPO
- Intubation, if necessary
- Succinylcholine and ketamine <3mg/kg do not increase intraocular pressure or cause adverse outcomes[2]
Disposition
- Admission for surgical repair by ophthalmology
- Transfer to tertiary trauma center if ophthalmologist prefer