Ophthalmology Book

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Globe PerforationAka: Globe Rupture

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  1. See Also
    1. Eye Injury
    2. Eye Injury in Sports
  2. Risk Factors: Consider referral to Ophthalmology in these cases regardless of exam
    1. See Eye Injury in Sports
    2. Rotating machinery is high risk for occult perforation
    3. High velocity trauma (in which high speed small shrapnel could pierce globe)
    4. Conjunctival Laceration (esp. if greater than 1 cm)
  3. Symptoms
    1. Severe Eye Pain
    2. Decreased Visual Acuity
  4. Signs
    1. Significant changes
      1. Hyphema (anterior chamber bleeding)
      2. Altered Red Reflex on Funduscopic Examination
      3. Uvea with dark pigmentation
      4. Tear shaped pupil
    2. Subtle signs
      1. Subconjunctival Hemorrhage (especially if involves 360 degrees around Cornea)
      2. Loss of Anterior Chamber Depth
      3. Conjunctival Laceration
  5. Exam
    1. See Eye Evaluation in Trauma
    2. Seidel Test
    3. Do not perform tonometry
  6. Imaging: CT Head and Orbits (both coronal and axial views)
    1. Orbital Wall Fracture
    2. Intraocular foreign body
    3. Open globe injury
  7. Management: Immediate Management
    1. Immediate referral to Ophthalmology
    2. Do not remove protruding foreign bodies
    3. Shield eye immediately
    4. Keep NPO
    5. Prevent Valsalva (increases Intraocular Pressure and further aqueous leakage)
      1. Ensure adequate analgesia with scheduled pain medications
      2. Prevent Vomiting with scheduled Antiemetics
      3. Antitussives if cough present
  8. Management: Prevent Endophthalmitis
    1. Tetanus prophylaxis if not current
    2. Start antibiotics within 6 hours of injury
      1. Adult typical antibiotic coverage
        1. Cefazolin 1 gram IV every 8 hours AND
        2. Ciprofloxacin 400 mg IV every 12 hours
      2. Child typical antibiotic coverage
        1. Cefazolin 25-50 mg/kg/day divided every 8 hours IV AND
        2. Gentamicin 2 mg/kg IV every 8 hours
      3. Modify antibiotic coverage in special circumstances
        1. Dog Bite (add Eikenella corrodens coverage)
        2. Cat Bite (add Pasteurella multocida coverage)
        3. Hay, leaves or other organic material (add fungal coverage)
  9. Complications
    1. Permanent vision loss
    2. Endophthalmitis (intraocular infection)
  10. References
    1. Rubasamen in Yanoff (2004) Ophthalmology, Ch. 140
    2. Pokhrel (2007) Am Fam Physician 76:829

Rupture of globe (C0339052)

ConceptsInjury or Poisoning (T037)
EnglishRupture of globe
Spanishruptura de globo ocular
Parent ConceptsInjury of globe of eye (C0339055), Duplicate concept (C1274013)
SourcesSCTSPA, SNOMEDCT
Derived from the NIH UMLS (Unified Medical Language System)


Perforating scleral wound (C0339198)

ConceptsInjury or Poisoning (T037)
EnglishPerforating scleral wound, Perforation of globe
Spanishherida escleral penetrante, perforacion del globo ocular, perforacion ocular
Parent ConceptsInjury wounds (C0043250), Injury of sclera (C0339197)
SourcesSCTSPA, SNOMEDCT
Derived from the NIH UMLS (Unified Medical Language System)



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