Morning Report: Globe Rupture

Thank you Dr. Joyce 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)