Globe Rupture Treatment & Management

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

Prehospital Care

  • A suspected or obvious ruptured globe should be protected from any pressure or inadvertent contact with a rigid shield during transport.
  • Impaled foreign bodies should be left undisturbed.
  • Eye patches are contraindicated.
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Emergency Department Care

  • A Fox eye shield or other rigid device (bottom of a polystyrene foam cup) should be placed over the affected eye. Avoid any eye manipulation that may increase intraocular pressure with potential extrusion of intraocular contents.
  • Administer antiemetics (eg, ondansetron) to prevent Valsalva maneuvers.
  • Administer sedation and analgesics as needed.
  • Avoid any topical eye solutions (eg, fluorescein, tetracaine, cycloplegics).
  • Administer prophylactic antibiotics to prevent endophthalmitis or an internal eye infection. The frequency of endophthalmitis after open globe injury has been estimated to be about 6.8%.[12] Skin organisms, such as Streptococcus species, Staphylococcus aureus, and Staphylococcus epidermidis are most frequently involved. Attention should be given to species-specific pathogens if injury is due to bites (ie, dysgonic fermenter type 2 [DF2] and Eikenella for dog bites; Pasteurella multocida for cat bites) or if organic material is likely to have been introduced (ie, gram-negative organisms or fungi in a farming injury).
  • Document tetanus immune status and update as indicated. An open globe laceration is considered a tetanus prone wound.
  • Ensure the patient is kept nothing by mouth (NPO).
  • Ensure definitive management by an ophthalmologist.
  • Surgical repair should be expedited.
  • The use of intraocular steroids is controversial. Ocular steroids should probably not be used if fungal infection is suspected.[4]
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Consultations

  • Ophthalmologist: Suspected globe rupture mandates urgent ophthalmology consultation.
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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].

 
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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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