An 18 yo M presents to the ED after being hit in the L eye with a roman candle. He reports pain w/ extraocular movement and vision loss. On exam, is unable to open his eye and has marked periorbital swelling. A CT facial bones is obtained. What's the diagnosis?  (scroll down for answer)

Answer: L globe rupture

• On images below, note irregular border of the L eye (when compared to the right eye), the disruption of the clear margin between tissues of the eye and vitreous humor, free air within the L orbit (red arrow), and radiopaque foreign bodies (blue arrows)

• Occurs when outer membrane eye disrupted by penetrating or blunt trauma

• Opthalmalogic emergency- anticipate patient will go directly to OR following optho eval
• Avoid anything that may increase intraocular pressure (do NOT measure IOP)
• Place shield over eye to avoid further unintentional injury
• Patient should receive broad spectrum antibiotics, tetanus, analgesics, and antiemetics (to prevent increase IOP from vomiting)
• In some cases, opthalmology is able to salvage vision

References:  Walker, Richard A., and Srikar Adhikari.. "Eye Emergencies." Tintinalli’s Emergency Medicine: A Comprehensive Study Guide, 8e Eds. Judith E. Tintinalli, et al. New York, NY: McGraw-Hill, 2016.