Globe rupture

Revision as of 17:47, 10 January 2015 by Rossdonaldson1 (talk | contribs)

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%

Differential Diagnosis

Maxillofacial Trauma

Management

Disposition

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

See Also

Source

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