How is globe rupture treated in the emergency department (ED)?

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

A Fox eye shield or other rigid device (bottom of a polystyrene foam cup) should be placed over the affected eye. Avoid any eye manipulation that may increase intraocular pressure with potential extrusion of intraocular contents.

Administer antiemetics (eg, ondansetron) to prevent Valsalva maneuvers.

Administer sedation and analgesics as needed.

Avoid any topical eye solutions (eg, fluorescein, tetracaine, cycloplegics) in cases of known globe perforation or rupture.

Administer prophylactic antibiotics. Although the goal is to prevent endophthalmitis or an internal eye infection, parenterally administered antibiotics penetrate the globe poorly. The frequency of endophthalmitis after open globe injury has been estimated to be about 6.8%. [14] Skin organisms, such as Streptococcus species, Staphylococcus aureus, and Staphylococcus epidermidis are most frequently involved. Consequently, intravenous third-generation cephalosporins and vancomycin have been recommended in high-risk cases. Attention should be given to species-specific pathogens if injury is due to bites (ie, dysgonic fermenter type 2 [DF2] and Eikenella for dog bites; Pasteurella multocida for cat bites) or if organic material is likely to have been introduced (ie, gram-negative organisms or fungi in a farming injury).

Document tetanus immune status and update as indicated. An open globe laceration is considered a tetanus prone wound.

Ensure the patient is kept nothing by mouth (NPO).

Ensure definitive management by an ophthalmologist.

Surgical repair should be expedited.

The use of intraocular steroids is controversial. Ocular steroids should probably not be used if fungal infection is suspected. [5]


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