Globe Rupture

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  • Globe rupture – what is it, what should I do, what shouldn’t I do???

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  • What is it and how do I know if my patient has it?

    • Anything the compromises the integrity of the cornea or sclera

    • This can range from a puncture to complete destruction of the globe

    • You should suspect it when someone has moderate to severe pain, decreased vision, hyphema, and deviation of the pupil

    • Keep in mind, many traumas happen when a patient is drunk, and may not be able to describe whether he’s having pain there or blurred vision

      • Have a high suspicion for globe rupture whenever the orbit seems at all abnormal in a trauma patient

    • To test, you can use the slit lamp

      • You may notice an irregular or deviated pupil

      • The patient will have a positive Seidel test

  • To perform a Seidel test, apply fluorescein directly to the suspected site of injury

  • If there is an injury, the aqueous will be leaking out of this site

  • As a result, the test is positive when you see a dark (ie diluted) stream within a lot of bright green (ie concentrated) dye

    • You can also get a CT of the head and orbits which can help confirm the diagnosis as well as evaluate for other problems like foreign bodies and orbital wall fractures

  • OK, so my patient has a globe rupture, now what?

    • Place an eye shield over the eye

      • This will help any pressure from accidentally being applied to the eye

      • If you don’t have an eye shield, you can make one: cut off the bottom of a Styrofoam cup and tape it over the eye

    • Start antibiotics

      • This is to prevent endophthalmitis, an intraocular infection that can lead to blindness

      • Common bacterial causes of enophthalmitis are Streptococcus, Staphylococcus aureus, and Staphylococcus epidermidis

      • Fluoroquinolones, aminoglycosides, and cephalosporins are common agents of choice to prevent endophthalmitis

    • Get the specialist involved

      • These patients need ophthalmology urgently.  Consult them immediately and transfer if they are not available in house  

  • Awesome! Is there anything I really shouldn’t do?

    • Avoid putting any unnecessary pressure on the eye!

      • A tonopen applies increased pressure to the eye, so don’t do it!

      • This is because it can lead to the release of intraocular contents, worsening his condition

    • Don’t pull out any foreign bodies!

      • If you see a foreign body sticking out, leave it be and let the specialist manage it

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