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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.


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]



Ophthalmologist: Suspected globe rupture mandates urgent ophthalmology consultation.

Contributor Information and Disclosures

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.


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.


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.

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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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