Globe rupture


  • 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


  • 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

Differential Diagnosis

Maxillofacial Trauma


  • Inspect lids, lashes, cornea, sclera, and pupils.
  • Evaluate for a relative afferent pupillary defect
  • Visual Acuity
  • Do NOT perform tonometry for IOP


  • Non-contrast CT orbit
    • Consider if concern for intraocular foreign body OR diagnosis is unclear
    • Sensitivity ~60%



  • Admission for surgical repair by ophthalmology
  • Transfer to tertiary trauma center if ophthalmologist prefer

See Also


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