Morning Report: Globe Rupture

Thanks to Dr. Wang for today’s Morning Report!

Globe Rupture

• Occurs when a blunt object impacts the orbit
• Ruptures are commonly at the site where sclera is thinnest – insertion of the extraocular muscles or at the limbus
• History
  • Type of object
  • Time of injury
  • Contact lenses?
  • Prior history of ocular surgery
  • Eye drops
  • Time of last meal
• Physical
  • Eye can be misshaped with uveal tissue prolapsing out of anterior chamber
  • AVOID putting pressure on ruptured globe to provide any additional damage
  • Test visual acuity in both injured and uninjured eyes
  • Evaluated extra ocular movement to r/o entrapment from associated orbital floor fracture
  • Orbits should be examined for bony deformity, foreign body, and globe displacement.
  • Cornea: a full thickness laceration to the cornea or sclera constitute as an open globe perforation – OR repair necessary
  • Pupils: peaked, teardrop-shaped or irregularly pupils indicate globe rupture. Examine for shape, size, light reflex, and afferent pupillary defect
• Imaging
  • Obtain CT for occult open globe injuries, optic nerve injury or small foreign bodies
  • Ultrasound: ocular ultrasound is contraindicated
• ED care
  • Fox eye shield should be placed over the affected eye (avoid eye manipulation that may increase intraocular pressure)
  • Administer antiemetics to prevent Valsalva maneuvers
  • Tetanus
  • Ophthalmology consult
  • Surgical repair

References:

http://emedicine.medscape.com/article/798223-overview

http://www.uptodate.com/contents/open-globe-injuries-emergent-evaluation-and-initial-management

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Jay Khadpe MD

• Editor in Chief of "The Original Kings of County"
• Assistant Professor of Emergency Medicine
• Assistant Residency Director
• SUNY Downstate / Kings County Hospital

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