Globe Rupture Follow-up

  • Author: Derek J Golden, MD; Chief Editor: Steven C Dronen, MD, FAAEM   more...
 
Updated: Feb 18, 2010
 

Further Inpatient Care

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

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.
Previous
Next

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.
Previous
Next

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.
Previous
Next

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.
Previous
Next

Patient Education

Previous
 
Contributor Information and Disclosures
Author

Derek J Golden, MD  Resident Physician, Department of Emergency Medicine, North Shore University Hospital

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

Disclosure: Nothing to disclose.

Coauthor(s)

John R Acerra, MD  Assistant Professor, Department of Emergency Medicine, Albert Einstein College of Medicine; Associate 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, Emergency Medicine Residents Association, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Specialty Editor Board

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

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

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD  Senior Pharmacy Editor, eMedicine

Disclosure: eMedicine Salary Employment

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.

John D Halamka, MD, MS  Associate Professor of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center; Chief Information Officer, CareGroup Healthcare System and Harvard Medical School; Attending Physician, Division of Emergency Medicine, Beth Israel Deaconess Medical Center

John D Halamka, MD, MS is a member of the following medical societies: American College of Emergency Physicians, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Chief Editor

Steven C Dronen, MD, FAAEM  Director of Emergency Services, Director of Chest Pain Center, Department of Emergency Medicine, Ft Sanders Sevier Medical Center

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

Disclosure: Nothing to disclose.

References

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

  2. Olitsky S, Hug D, Smith L. Injuries to the eye. In: 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. Feb 2008;26(1):97-123, vi-vii. [Medline].

  4. Rubasmen PE. Posterior segment ocular trauma. In: 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. Mar 1995;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. Jul 2005;59(1):175-8. [Medline].

  7. Rodriguez JO, Lavina AM, Agarwal A. Prevention and treatment of common eye injuries in sports. Am Fam Physician. Apr 1 2003;67(7):1481-8. [Medline].

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

  9. Harlan JB Jr, Pieramici DJ. Evaluation of patients with ocular trauma. Ophthalmol Clin North Am. Jun 2002;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. Aug 2007;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. Oct 26 2009;[Medline].

  12. Essex RW, Yi Q, Charles PG, Allen PJ. Post-traumatic endophthalmitis. Ophthalmology. Nov 2004;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. Jun 2009;27(5):530-5. [Medline].

  14. Vachon CA, Warner DO, Bacon DR. Succinylcholine and the open globe. Tracing the teaching. Anesthesiology. Jul 2003;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. In: 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. Jan 3 2004;328(7430):36-8. [Medline].

 
Previous
Next
 
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.
 
 
 
All material on this website is protected by copyright, Copyright © 1994-2012 by WebMD LLC.
This website also contains material copyrighted by 3rd parties.

DISCLAIMER: The content of this Website is not influenced by sponsors. The site is designed primarily for use by qualified physicians and other medical professionals. The information contained herein should NOT be used as a substitute for the advice of an appropriately qualified and licensed physician or other health care provider. The information provided here is for educational and informational purposes only. In no way should it be considered as offering medical advice. Please check with a physician if you suspect you are ill.