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Globe Rupture Treatment & Management

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

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) in cases of known globe perforation or rupture.

Administer prophylactic antibiotics. Although the goal is to prevent endophthalmitis or an internal eye infection, parenterally administered antibiotics penetrate the globe poorly. 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

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].

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  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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