Penetrating Trauma Ruptured Globe

Penetrating ocular trauma can occur from numerous sources (BB pellets, lawn mower projectiles, hammering, knife and gunshot wounds). Any projectile injury has the potential for penetrating the eye. Any lid laceration from a sharp object, especially if it involves the upper and lower eyelid has the potential to have lacerated the globe and requires a slit-lamp examination. Clues to a ruptured globe or intraocular foreign body include shallow anterior chamber, hyphema, irregular pupil, significant reduction in preinjury visual acuity, and poor view of the optic nerve and posterior pole on direct ophthalmoscopy. It is not unreasonable to dilate the eye with Mydriacyl 1% and phenylephrine 2.5% to obtain a better view of the posterior segment of the eye, facilitating identification of an intraocular foreign body or retinal detachment. A modified Seidel test is helpful in identifying wound leaks (see Fig.: 230-7). Any penetrating injury is considered a ruptured globe and mandates an eye shield and ophthalmology consultation. Tetanus status should be determined and intravenous cephalosporin administered. Do not attempt to measure IOP if a ruptured globe is suspected. A Waters view x-ray and orbital CT scans can be helpful in locating and confirming the presence of orbital and intraocular foreign bodies.

Treatment:

1. If ruptured globe suspected, do not attempt to check IOP, place a protective metal eye shield, check tetanus status, administer intravenous cephalosporin, caution the patient to take nothing by mouth, and call ophthalmology.

2. Obtain a Waters view x-ray and/or orbital CT scans if foreign bodies are suspected.

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