Ruptured Globe and Intraocular Foreign Body

A ruptured globe is caused by a penetrating or blunt blow to the eye that results in a full-thickness scleral or corneal disruption. The patient's history may include exposure to a highvelocity projectile (including hammering metal) or blunt trauma (including air bag). A high index of suspicion is paramount, since up to 50% of ruptures are occult.

Causes

• Ruptured globe in adults may occur after blunt injury during motor vehicle accidents, sports activity, assault, or other trauma.
• Ruptured globe or perforation may occur with gunshot and stab wounds, workplace accidents, and other accidents involving sharps or projectiles.

Symptoms

• Decreased vision
• Nausea and vomiting
• Eye pain

Signs

Examine both eyes for comparison

• Decreased visual acuity ++++
• No obvious evidence of rupture +++
• Decreased lOP ++++, although in obvious rupture it is prudent to avoid tonometry.
• Hyphema ++++, limited specificity. Ruptured globe must be ruled out when hyphema is present.
• Hemorrhagic chemosis ++++, if subconjunctival hemorrhage of > 180 degrees.
• Afferent pupillary defect ++++, limited specificity
• Ovaling or pear-shaped tenting of the pupil is a subtle but specific sign.
• Fluorescein streaming indicates a full-thickness corneal laceration.
• Increased or decreased depth of anterior chamber ++++
• Vitreal hemorrhage ++++, specificity limited

Treatment

• 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.
• Surgical repair is needed to remove foreign bodies that have penetrated inside the eye. This usually takes the form of a vitrectomy, which involves going into the eye to remove the foreign material.

Prevention

• Wearing appropriate safety glasses is the best way to prevent this type of injury.
• If a particle of wood, glass, metal or any other foreign substance becomes trapped in your eye, then do not touch or rub your eyes and seek professional help immediately.