Globe Rupture

Globe Rupture is a topic covered in the 5-Minute Emergency Consult.

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Basics

Description

  • A full-thickness corneal or scleral injury owing to trauma
  • Blunt trauma/globe rupture:
    • Causes an abrupt rise in intraocular pressure diffusely
    • Subsequent rupture of the eye either opposite the point of impact or at the weakest points:
      • Extraocular muscle insertion
      • Corneoscleral junction
      • Limbus, where the sclera is thinnest
  • Penetrating injury/globe laceration:
    • Occurs with sharp objects or projectiles injuring the sclera or anterior eye directly
    • Most commonly anterior and involving the cornea – the bony orbit protects the globe laterally and posteriorly
    • Posterior injury can occur with fracture of the bony orbit or with penetrating eyelid/eyebrow injuries
  • Prognosis worse with:
    • Larger lacerations
    • Posterior injuries
    • Blunt injury
    • Intraocular foreign body, especially if made of organic material
    • Vitreous extrusion
    • Lens damage
    • Hyphema
    • Retinal detachment
    • Poor visual acuity at presentation
    • Afferent pupillary defect
    • Increased time to OR

Etiology

  • Falls, impact injuries
  • Sport-related injuries (e.g., elbow, ball impacts, arrows, game controllers, etc.)
  • Indirect concussive injuries (explosions)
  • Sharp instrument/stabbing injuries, accidental or intentional
  • High-velocity projectile injuries (industrial, firearms, BB pellets, blast explosion shrapnel)

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Basics

Description

  • A full-thickness corneal or scleral injury owing to trauma
  • Blunt trauma/globe rupture:
    • Causes an abrupt rise in intraocular pressure diffusely
    • Subsequent rupture of the eye either opposite the point of impact or at the weakest points:
      • Extraocular muscle insertion
      • Corneoscleral junction
      • Limbus, where the sclera is thinnest
  • Penetrating injury/globe laceration:
    • Occurs with sharp objects or projectiles injuring the sclera or anterior eye directly
    • Most commonly anterior and involving the cornea – the bony orbit protects the globe laterally and posteriorly
    • Posterior injury can occur with fracture of the bony orbit or with penetrating eyelid/eyebrow injuries
  • Prognosis worse with:
    • Larger lacerations
    • Posterior injuries
    • Blunt injury
    • Intraocular foreign body, especially if made of organic material
    • Vitreous extrusion
    • Lens damage
    • Hyphema
    • Retinal detachment
    • Poor visual acuity at presentation
    • Afferent pupillary defect
    • Increased time to OR

Etiology

  • Falls, impact injuries
  • Sport-related injuries (e.g., elbow, ball impacts, arrows, game controllers, etc.)
  • Indirect concussive injuries (explosions)
  • Sharp instrument/stabbing injuries, accidental or intentional
  • High-velocity projectile injuries (industrial, firearms, BB pellets, blast explosion shrapnel)

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