SAEM Clinical Image Series: Eye Trauma and Vision Loss

Open globe or globe rupture occurs when the integrity of the eye is disrupted by blunt or penetrating trauma. Globe rupture is an ophthalmologic emergency and requires definitive management by an ophthalmologist.

Diagnosis:

• Look for a misshapen eye or misshapen pupil; less commonly, you may see prolapsing of uveal tissue.
• In cases where uncertainty exists, use fluorescein staining and look for a positive Seidel’s test – a clear stream of fluid parting the yellow dye, noted on Wood’s lamp evaluation.
• If there is concern for ocular foreign body or uncertainty in diagnosis, a CT orbit is appropriate.

Pearls:

• If open globe or ruptured globe is suspected avoid putting pressure of any kind on the eye to prevent worsening of injury and extrusion of intraocular contents.
• Do not check intraocular pressures, or do ultrasound examination of the eye.

Treatment:

• Place an eye shield
• Give patient anti-emetics to prevent increased in intra-ocular pressure
• Provide analgesia
• Give prophylactic antibiotics covering skin flora
• Administer tetanus as indicated
• Consult ophthalmology as soon as possible. If you are working without local ophthalmology coverage, transfer to an appropriate facility is indicated.

Take Home Points:

• For suspected open globe injuries, place an eye shield, give antiemetics, analgesics, antibiotics, and tetanus immunization.
• Obtain an early ophthalmology consultation.
• Avoid pressure of any kind on the eye, avoid eye manipulation, and avoid topical eye solutions.