Open globe injuries: Emergent evaluation and initial management
- Christopher M Andreoli, MD
Christopher M Andreoli, MD
- Clinical Instructor in Ophthalmology
- Harvard Medical School
- Matthew F Gardiner, MD
Matthew F Gardiner, MD
- Assistant Professor of Ophthalmology
- Harvard Medical School
- Section Editors
- Richard G Bachur, MD
Richard G Bachur, MD
- Section Editor — Pediatric Trauma
- Professor of Pediatrics and Emergency Medicine
- Harvard Medical School
- Evelyn A Paysse, MD
Evelyn A Paysse, MD
- Section Editor — Pediatric Ophthalmology
- Professor of Ophthalmology and Pediatrics
- Baylor College of Medicine
- Maria E Moreira, MD
Maria E Moreira, MD
- Section Editor — Adult Trauma
- Associate Professor, Department of Emergency Medicine
- University of Colorado Denver School of Medicine
- Residency Program Director
- Denver Health Residency in Emergency Medicine
- Deputy Editor
- James F Wiley, II, MD, MPH
James F Wiley, II, MD, MPH
- Senior Deputy Editor — Adult and Pediatric Emergency Medicine
- Senior Deputy Editor — Primary Care Sports Medicine (Adolescents and Adults)
- Professor of Pediatrics and Emergency Medicine/Traumatology
- University of Connecticut School of Medicine
A traumatic breakdown in the integrity of the wall of the eye (sclera or cornea) is known as an open globe injury. Prompt recognition of open globe injuries and referral to an ophthalmologist are essential to maximize visual restoration and outcome.
The approach to the patient with an open globe injury is summarized in a rapid overview (table 1).
Open globe injuries are described by mechanism and then by anatomic site [1,2].
Open globe rupture — Open globe rupture occurs following blunt eye injury, typically at the site of greatest structural weakness near the equator and directly behind the insertion of the rectus muscles. (picture 1) . (See 'Pathophysiology' below.)
Open globe laceration — Open globe laceration refers to a penetrating injury to the eye by a sharp object or projectile and is further subclassified as penetrating (entry wound but no exit wound) or perforating (entry and exit wounds) . Intraocular foreign body (IOFB) injuries refer to a foreign body present anywhere inside the interior of the globe and are grouped separately because studies have shown that they have a different prognosis (picture 2) [3,4].
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- Open globe rupture
- Open globe laceration
- Zone of injury
- Blunt injury
- Penetrating injury
- Extrusion of ocular contents
- CLINICAL FEATURES
- Physical examination
- - Inspection
- - Visual acuity
- - Relative afferent pupillary defect
- - Other findings
- - Injury to adjacent structures
- PRIMARY EVALUATION AND MANAGEMENT
- Initial emergency assessment and treatment
- Ophthalmology consultation
- Additional emergency treatment
- - NPO (nil per os) status
- - Empiric antibiotic therapy
- - Tetanus prophylaxis
- DEFINITIVE MANAGEMENT
- SUMMARY AND RECOMMENDATIONS
- Clinical findings
- Evaluation and management