A 27 y.o. is hit in the L eye when a high pressure hose explodes. His vision is normal.
what possible injuries could have occurred?
you note that the pupil is round and reactive
Our patient had a perforation of the globe. The confusing picture in this case is that the classic presentation of irregular pupil, vision loss or a Seidel sign are absent. There is a relative contraindication to ultrasound because it may increase intraocular pressure. Our patient was taken to the OR and the scleral injury was repaired. Vitreous was noted extruding from the wound and it was removed. Antibiotics were given and the patient had an excellent visual outcome
A small perforation was noted inferiorly
Globe rupture can occur either from blunt trauma like airbag deployment or penetrating trauma. In the US, estimated cases of globe rupture are approximately 3 per 100,000. Imaging is unreliable to diagnose globe rupture. In children scissors are the most likely cause of globe rupture while in adults workplace injuries and motor vehicle collisions are most common. In the elderly, ground level falls account for the majority of cases.
Two newer causes of globe rupture have occurred. LASIK surgery compromises the biomechanical stability of the cornea. Corneal ectasia can be inadvertently induced by the surgeon and complications may not occur until months after the surgery. The weakening of the cornea can be associated with ocular rupture in traumatic injuries. Airbags are also an infrequent cause of globe rupture.
lasik thins the corneal to improve vision quality
Fun facts
If patients with globe rupture need intubation choose rocuronium as it does not increase intraocular pressure as much as succinylcholine or ketamine.
Fibrous proliferation along the tract of a foreign body can lead to retinal detachment and often a vitrectomy is performed.
The most common pathogens following globe rupture are Bacillus cereus and gram negative organisms.
Sympathetic ophthalmia is a devastating complication of globe perforation with a diffuse bilateral panuveitis developing after immune system sensitization to the intraocular contents. Blindness results.
Pt with a globe rupture and canalicular injury after being shot with a beanbag gun
Hughes E, Fahy G. A 24-month review of globe rupture in a tertiary referral hospital. Ir J Med Sci 2020 May; 189(2):723-26.
Andreoli M, Andreoli C. geriatric traumatic open globe injureis. Ophthalmology. 2011Jan;118(1): 156-9.
Jindal A, Pathengay A, Mithal K, et al. Endopthalmitis after open globe injuries: changes in microbiological spectrum and isolate susceptibility patterns over 14 years. J Ophthalmic Inflamm Infec 2014 Feb;4(1)5.
Duma S, Jernigan M, Stitzel,et al. The effect of frontal airbags on eye injury patterns in automobile crashes. 2002 Arch Ophthalmol. 120(11):1517-1522.