Open Globe Injury
For the less obvious ruptured globes, which may sometimes mimic a corneal or conjunctival abrasion, it is imperative to perform a Seidel test carefully - Rehan Hussain MD
image by: BruceBlaus
HWN Suggests
Open Globe Injury
The presentation of open globe injuries can vary widely depending on the mechanism of injury, and so can the final visual outcome. For obvious ruptured globes with peaked pupils or extruding intraocular contents... it is best to avoid any manipulation of the eye to prevent further extrusion of contents or increase the risk of infection. Cover the eye with a shield, start topical and systemic antibiotics, and consult ophthalmology so they can arrange surgery in a timely manner. The patient must be kept NPO to avoid delaying surgery unnecessarily. Definitely don’t check the eye pressure if you already know it is a ruptured globe.
Resources
How to Assess Whether a Globe is Ruptured
If there is any concern that a patient may have an open globe, the top priority is avoiding further damage to the eye. This means special precautions must be taken immediately to assess whether this is the case. Until the integrity of the globe is confidently established, do not place external pressure of any sort on the eye of concern.
Missing the Point—Eye Injury
Although intraocular pressure might be lowered in penetrating globe injury, ocular pressure assessment (tonometry) should not be performed, and any maneuvers that potentially increase intraocular pressure must be avoided.
Approach to Ocular Trauma
Caused by sharp or blunt trauma, patients suffering from open globe injury present with acute eye pain that may or may not be accompanied with reduced VA.
Blunt Ocular Trauma Live from The EM Cases Course
A careful assessment of globe symmetry from the head of the bed may reveal a subtle enophthalmos. Any irregularly shaped pupil (not only the classic ‘tear-drop’ shaped pupil) should raise your suspicion for a globe rupture. A large circumferential edematous traumatic subconjunctival hemorrhage as well as a uveal prolapse are concerning for a globe rupture. Remember that assessment of IOP is contraindicated in patients with suspected globe rupture.
EM@3AM: Open Globe Injury
An open globe can present subtly with no obvious external injury. If a patient’s history and mechanism are consistent with the injury, maintain a high index of suspicion.
Globe Rupture
If you don’t have an eye shield, you can make one: cut off the bottom of a Styrofoam cup and tape it over the eye.
Traumatic Ocular Injuries
Cover with an eye shield (do not place eye patch as it exerts pressure on globe) – A paper cup can be used if an eye shield is not available
Open Globe Injury
For the less obvious ruptured globes, which may sometimes mimic a corneal or conjunctival abrasion, it is imperative to perform a Seidel test carefully.
10 Pearls for Open Globe Trauma Assessment
Assume that any periocular or ocular trauma could include a ruptured globe. Avoid placing undue pressure on the globe until you establish that an open globe injury does not exist.
StatPearls
Globe rupture, globe laceration, globe perforation, or open globe injuries are forms of ocular trauma that require urgent diagnosis and treatment. Globe rupture is the common term used to describe all potential types of open globe injuries.
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