The diagnosis of globe rupture may be obvious, although this is not the most common presentation. The eye can be misshapen with uveal tissue prolapsing out of an anterior scleral or corneal wound. Sometimes, an identifiable foreign body is still in the eye when the patient arrives to the ED.
More often, the diagnosis of globe rupture is not immediately apparent. The most frequent sites of rupture are not easily visualized, and more superficial injuries may block examination of the posterior segment. In cases of blunt trauma, swelling of the face and lids may complicate visualization of the eye. Penetrating injuries from very small sharp objects may create tiny wounds that are difficult to visualize.
Examination of the injured eye should proceed systematically with the goal of identifying and protecting a ruptured globe.
It is critical to avoid putting pressure on a ruptured globe to prevent extrusion of intraocular contents and further ocular injury.
In young children where the extent of intraocular injury cannot be assessed because of poor cooperation, sedation and support from an ophthalmologist may be necessary to ensure a complete and accurate examination.
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Operating microscope view of a globe rupture secondary to blunt trauma by a fist. Notice the dark arc in the bottom of the photo representing the ciliary body visible through the scleral breach. Subconjunctival hemorrhage of this severity should raise suspicion of occult globe rupture. Photo courtesy of Brian C Mulrooney, MD.
