Globe rupture

Revision as of 20:37, 12 September 2013 by Westafer (talk | contribs) (DDx)

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

  1. Blunt Eye Trauma
    1. Caused by suddenly elevated IOP
  2. Penetrating trauma
    1. Suspect globe penetration w/ any puncture or laceration of eyelid or periorbital area
    2. More commonly assoc w/ objects from metal on metal, lawn mower, drills, grinders

Clinical Features

  1. Eye pain
  2. +/- decreased visual acuity
  3. Tear-shaped pupil
  4. Extrusion of intraocular content
  5. Subconjunctival hemorrhage involving entire sclera
  6. Hemorrhagic chemosis
  7. Slit-lamp
    1. Shallow anterior chamber
    2. Hyphema
    3. Seidel's sign - do not perform this test if suspect open globe
      1. May be falsely negative if scleral rupture is small
    4. 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%

DDx

Treatment

  • Consult ophtho immediately
  • Do not manipulate the eye
    • No eye drops
  • Eye covering with metal shield or paper cup
  • Elevate head of bed
  • Treat nausea/vomiting
  • Broad spectrum IV ABX
    • Ceftazidime 1gm + vanco 1 gm
    • PCN allergy: Cipro + vanco
  • Tetanus, if indicated
  • Keep patient NPO
  • If intubation necessary, recent studies show succinylcholine and ketamine <3 mg/kg are ok.

Disposition

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

See Also

Orbital Blowout Fracture

Source

  • Tintinalli
  • UpToDate
  • Rosen's