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Globe Rupture Follow-up

  • Author: John R Acerra, MD; Chief Editor: Steven C Dronen, MD, FAAEM  more...
 
Updated: Oct 26, 2015
 

Further Inpatient Care

Further care of patients with globe rupture is at the discretion of the consulting ophthalmologist.

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Transfer

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.

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Deterrence/Prevention

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.

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Complications

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.

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Prognosis

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.[13] 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.[5]

The prognosis should be guarded until after surgical evaluation.

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Patient Education

For patient education resources, see the Eye and Vision Center, as well as Subconjunctival Hemorrhage (Bleeding in Eye).

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Contributor Information and Disclosures
Author

John R Acerra, MD Assistant Professor, Department of Emergency Medicine, Hofstra North Shore-LIJ School of Medicine; Director, International Emergency Medicine Fellowship, North Shore-LIJ Health System

John R Acerra, MD is a member of the following medical societies: American College of Emergency Physicians, Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Coauthor(s)

Derek J Golden, MD Attending Physician, Department of Emergency Medicine, West Hills Hospital and Medical Center

Derek J Golden, MD is a member of the following medical societies: American College of Emergency Physicians, American Medical Association

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Douglas Lavenburg, MD Clinical Professor, Department of Emergency Medicine, Christiana Care Health Systems

Douglas Lavenburg, MD is a member of the following medical societies: American Society of Cataract and Refractive Surgery

Disclosure: Nothing to disclose.

Chief Editor

Steven C Dronen, MD, FAAEM Chair, Department of Emergency Medicine, LeConte Medical Center

Steven C Dronen, MD, FAAEM is a member of the following medical societies: American Academy of Emergency Medicine, Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Additional Contributors

Edward A Michelson, MD Associate Professor, Program Director, Department of Emergency Medicine, University Hospital Health Systems of Cleveland

Edward A Michelson, MD is a member of the following medical societies: American College of Emergency Physicians, National Association of EMS Physicians, Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Acknowledgements

The authors and editors of Medscape Reference gratefully acknowledge the contributions of previous authors, Joe Robson, MD, Amy J Behrman, MD, and Stephanie Abbuhl, MD, to the development and writing of this article.

References
  1. Sharma R, Brunette DD. Ophthalmology. Marx, ed. Rosen's Emergency Medicine. 7th ed. 2009. Vol 2: Chap 69.

  2. Olitsky S, Hug D, Smith L. Injuries to the eye. Kliegman R, ed. Nelson Textbook of Pediatrics. 18th ed. 2007. Chap 634.

  3. Bord SP, Linden J. Trauma to the globe and orbit. Emerg Med Clin North Am. 2008 Feb. 26(1):97-123, vi-vii. [Medline].

  4. Rubasmen PE. Posterior segment ocular trauma. Yanoff M, Duker J, eds. Ophthalmology. 3rd ed. 2008. 6.42.

  5. 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].

  6. 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].

  7. 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].

  8. Listman DA. Paintball injuries in children: more than meets the eye. Pediatrics. 2004 Jan. 113(1 Pt 1):e15-8. [Medline].

  9. Harlan JB Jr, Pieramici DJ. Evaluation of patients with ocular trauma. Ophthalmol Clin North Am. 2002 Jun. 15(2):153-61. [Medline].

  10. 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].

  11. 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].

  12. Essex RW, Yi Q, Charles PG, Allen PJ. Post-traumatic endophthalmitis. Ophthalmology. 2004 Nov. 111(11):2015-22. [Medline].

  13. 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].

  14. Vachon CA, Warner DO, Bacon DR. Succinylcholine and the open globe. Tracing the teaching. Anesthesiology. 2003 Jul. 99(1):220-3. [Medline].

  15. Libonati MM, Leahy JJ, Ellison N. The use of succinylcholine in open eye surgery. Anesthesiology. May 1985. 62:637-639. [Medline].

  16. Augsburger J, Asbury T. Ocular & orbital trauma. Rioodan-Eva P, Whitcher JP, eds. Vaughan & Asbury's General Ophthalmology. 17th ed. 2007. Chap 19.

  17. Khaw PT, Shah P, Elkington AR. Injury to the eye. BMJ. 2004 Jan 3. 328(7430):36-8. [Medline]. [Full Text].

  18. 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].

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Operating microscope view of a globe rupture secondary to blunt trauma by a fist. Notice the dark arc in the bottom of the photo representing the ciliary body visible through the scleral breach. Subconjunctival hemorrhage of this severity should raise suspicion of occult globe rupture. Photo courtesy of Brian C Mulrooney, MD.
 
 
 
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