Globe Rupture Follow-up
- Author: John R Acerra, MD; Chief Editor: Steven C Dronen, MD, FAAEM more...
Further Inpatient Care
Further care of patients with globe rupture is at the discretion of the consulting ophthalmologist.
Transfer may be necessary if the patient presents to an institution without ophthalmology consultation services or without the ability to provide the definitive surgical repair.
Proper protective eyewear is the mainstay of prevention of ocular injury.
Industrial sites are mandated to provide at-risk employees with protective eyewear.
Physicians should encourage their patients to use eye shields when using lawn-care, woodworking, or metalworking equipment.
After globe rupture, delayed postoperative or exogenous endophthalmitis, and infection involving the deep structures of the eye, are always potential complications.
Depending on the organism involved, endophthalmitis may present within hours of the globe rupture, or, as with fungal organisms, the infection may not appear until weeks later.
The prognosis depends largely on the extent of injury and the time from injury until appropriate surgical treatment.
In a study by Lee et al, the charts of 62 patients aged 16 years and younger who had been treated for open globe injuries were reviewed. In addition to location and extent of injury, unfavorable outcomes were also related to the initial presentation of hyphema, vitreous hemorrhage, retinal detachment, cornea wound across the pupil, and endophthalmitis.
In a retrospective review, Esmaeli et al studied 176 cases of ruptured globe to identify clinical and histopathologic factors that may predict ocular survival and final visual acuity after penetrating ocular trauma. Predictors of excellent final visual acuity (20/60 or better) were initial visual acuity of 20/200 or better, wound location anterior to the plane of insertion of the 4 rectus muscles, wound length 10 mm or less, and sharp mechanism of injury. Predictors of poor vision were initial visual acuity of light perception or no light perception, wounds extending posterior to rectus muscle insertion plane, wound length greater than 10 mm, and blunt or missile injury.
The prognosis should be guarded until after surgical evaluation.
Sharma R, Brunette DD. Ophthalmology. Marx, ed. Rosen's Emergency Medicine. 7th ed. 2009. Vol 2: Chap 69.
Olitsky S, Hug D, Smith L. Injuries to the eye. Kliegman R, ed. Nelson Textbook of Pediatrics. 18th ed. 2007. Chap 634.
Bord SP, Linden J. Trauma to the globe and orbit. Emerg Med Clin North Am. 2008 Feb. 26(1):97-123, vi-vii. [Medline].
Rubasmen PE. Posterior segment ocular trauma. Yanoff M, Duker J, eds. Ophthalmology. 3rd ed. 2008. 6.42.
Esmaeli B, Elner SG, Schork MA, Elner VM. Visual outcome and ocular survival after penetrating trauma. A clinicopathologic study. Ophthalmology. 1995 Mar. 102(3):393-400. [Medline].
Koo L, Kapadia MK, Singh RP, Sheridan R, Hatton MP. Gender differences in etiology and outcome of open globe injuries. J Trauma. 2005 Jul. 59(1):175-8. [Medline].
Rodriguez JO, Lavina AM, Agarwal A. Prevention and treatment of common eye injuries in sports. Am Fam Physician. 2003 Apr 1. 67(7):1481-8. [Medline].
Listman DA. Paintball injuries in children: more than meets the eye. Pediatrics. 2004 Jan. 113(1 Pt 1):e15-8. [Medline].
Harlan JB Jr, Pieramici DJ. Evaluation of patients with ocular trauma. Ophthalmol Clin North Am. 2002 Jun. 15(2):153-61. [Medline].
Arey ML, Mootha VV, Whittemore AR, Chason DP, Blomquist PH. Computed tomography in the diagnosis of occult open-globe injuries. Ophthalmology. 2007 Aug. 114(8):1448-52. [Medline].
Hoffstetter P, Schreyer AG, Schreyer CI, et al. Multidetector CT (MD-CT) in the Diagnosis of Uncertain Open Globe Injuries. Rofo. 2009 Oct 26. [Medline].
Essex RW, Yi Q, Charles PG, Allen PJ. Post-traumatic endophthalmitis. Ophthalmology. 2004 Nov. 111(11):2015-22. [Medline].
Lee CH, Lee L, Kao LY, Lin KK, Yang ML. Prognostic indicators of open globe injuries in children. Am J Emerg Med. 2009 Jun. 27(5):530-5. [Medline].
Vachon CA, Warner DO, Bacon DR. Succinylcholine and the open globe. Tracing the teaching. Anesthesiology. 2003 Jul. 99(1):220-3. [Medline].
Libonati MM, Leahy JJ, Ellison N. The use of succinylcholine in open eye surgery. Anesthesiology. May 1985. 62:637-639. [Medline].
Augsburger J, Asbury T. Ocular & orbital trauma. Rioodan-Eva P, Whitcher JP, eds. Vaughan & Asbury's General Ophthalmology. 17th ed. 2007. Chap 19.
Yuan WH, Hsu HC, Cheng HC, Guo WY, Teng MM, Chen SJ, et al. CT of globe rupture: analysis and frequency of findings. AJR Am J Roentgenol. 2014 May. 202 (5):1100-7. [Medline].