A globe rupture is a full-thickness tear of the cornea or sclera after blunt or penetrating eye trauma. It is a surgical emergency, and the main goal until the ophthalmologist arrives is to keep all pressure off the eye.
Key symptoms
- Eye pain after a blow, fall or flying object
- Sudden loss or blurring of vision
- Bloody or watery fluid leaking from the eye
- History of hammering metal or high-speed debris
What you find on exam
- Teardrop-shaped or irregular pupil pointing toward the wound
- Severe bloody swelling of the conjunctiva all around the cornea
- Visible tear, exposed dark tissue or a shallow anterior chamber
- Check visual acuity gently; do not press on the eye or measure its pressure
Tests
- CT of the orbits without contrast to find the injury and foreign bodies
- No MRI if a metal foreign body is possible
- Seidel test with fluorescein shows leaking fluid; skip it if rupture is obvious
- Basic labs and coagulation tests before surgery
Treatment basics
- Rigid eye shield over the eye, never a pressure patch
- Head of bed raised, patient calm, nothing by mouth
- Antiemetic such as ondansetron and pain control to avoid straining
- IV antibiotics and tetanus update
- Urgent ophthalmology for surgical repair
Red flags
- Irregular pupil or leaking fluid after eye trauma
- Major vision loss right after the injury
- Metal-on-metal injury, even with a tiny wound
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Sources: NASEMSO National Model EMS Clinical Guidelines; NCCPA PANCE Content Blueprint; NBOME COMLEX-USA clinical presentations. Written by Making Synapses. Making Synapses is not affiliated with these organizations.