Background
Globe rupture occurs when the integrity of the outer membranes of the eye is disrupted by blunt or penetrating trauma. Any full-thickness injury to the cornea, sclera, or both is considered an open globe injury and is approached in the same manner in the acute setting. Globe rupture is an ophthalmologic emergency and requires definitive management by an ophthalmologist. Although the globe's position within the orbit protects it from injury in many situations, damage to the posterior segment of the eye is associated with a very high frequency of permanent visual loss. Prompt recognition and ophthalmologic intervention are essential to maximizing functional outcome.
Globe rupture secondary to trauma is shown in the image below.
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. Pathophysiology
Globe rupture may occur when a blunt object impacts the orbit, compressing the globe along the anterior-posterior axis causing an elevation in intraocular pressure to a point that the sclera tears. Ruptures from blunt trauma are most common at the sites where the sclera is thinnest, at the insertions of the extraocular muscles, at the limbus, and at the site of previous intraocular surgery.[1, 2] Sharp objects or those traveling at high velocity may perforate the globe directly. Small foreign bodies may penetrate the eye and remain within the globe. The possibility of globe rupture should be considered and ruled out during the evaluation of all blunt and penetrating orbital traumas as well as in all cases involving high-speed projectiles with potential for ocular penetration.
Epidemiology
Frequency
United States
More than 2 million eye injuries occur in the United States annually, with more than 40,000 resulting in some degree of permanent visual impairment. Trauma to the eye represents approximately 3% of all ED visits in the United States.[3] One third of all cases of childhood blindness result from ocular trauma.
Mortality/Morbidity
- Globe rupture and posterior segment injury have always been associated with a high frequency of visual loss. With modern diagnostic techniques, surgical approaches, and rehabilitation, many eyes can be salvaged with retention of vision.[4]
- Patients should not be given a hopeful prognosis until full, usually operative, evaluation is complete. Predictors of poor final visual acuity after penetrating ocular trauma are initial visual acuity of only 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]
Race
- No racial predilection exists for globe rupture.
Sex
Age
- Globe rupture typically occurs at a younger age in men (median age, 36 y) than in women (median age, 73 y).[6]
- A high percentage of globe rupture occurrences are in adolescent boys.
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