Globe Rupture

• Vision threatening emergency
• Blunt or penetrating trauma that causes a sudden elevation of intraocular pressure
• Hx ocular surgery or previous ocular injury may predispose
• When suspected, cover eye with metal or protective eye shield
• Immediate consult to ophthalmology
• Do NOT measure intraocular pressure
• Examine with gentle retraction of eyelids (avoid increase IOP)
• May have decreased visual acuity; Irregular or teardrop shaped pupil; Afferent pupillary defect; Hyphema; Positive Seidel test (anterior chamber leakage with Fluorescein stain); Lens dislocation; Subconjunctival hemorrhage
• Elevate HOB
• Broad spectrum IV abx (ex. IV levofloxacin 500mg q24hr and IV cefazolin 1g q8H)
• Sedation, Analgesia and Antiemetic if needed to prevent increase IOP
• Update Tetanus
• NPO

References:

Walker RA, Adhikari S. "Eye Emergencies." Tintinalli’s Emergency Medicine: A Comprehensive Study Guide, 8eEds. Judith E. Tintinalli, et al. New York, NY: McGraw-Hill, 2016, pg 1568-69.