What is the focus of the clinical history for globe rupture?

Updated: Sep 03, 2019
  • Author: John R Acerra, MD; Chief Editor: Steven C Dronen, MD, FAAEM  more...
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Answer

The clinical history is important, and details regarding the circumstance and mechanism of injury should be obtained with the following in mind:

  • Before focusing on the eye injury, is there an associated extraocular injury (eg, subdural hemorrhage secondary to fall)?
  • What was the patient doing at the time of injury (eg, hammering metal)?
  • Is this activity more likely to cause a blunt, penetrating, and perforating injury? In men, projectile injuries are the most frequent cause of globe injuries and are often work-related or occur during home improvement projects. [7] Women are more likely to suffer blunt globe injury from falls or motor vehicle accidents.
  • What type of object is likely to have struck the globe?
  • Is it possible that there is an intraocular foreign body? Assume this to be true if a high-speed projectile was involved.
  • When did the injury occur?
  • Where did the injury occur (eg, home, construction site)?
  • What is the patient's baseline visual acuity? Severe myopia increases the risk of injury from anterior-posterior compression.
  • Does the patient use corrective lenses or contacts? If so, have contacts been removed?
  • If caused by a motor vehicle accident, was a seatbelt used and did airbags deploy?

Medical history may include the following:

  • Prior history of ocular surgery (prior cataract extraction increases the risk of an occult cataract wound rupture)

  • Preexisting medical conditions

  • Medications (including eye drops)

  • Medication allergies

  • Tetanus status

  • Time of last meal


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