Open Globe Management

Alessandro A. Castellarin, MD; Dante J. Pieramici, MD

Disclosures

Compr Ophthalmol Update. 2007;8(5):111-124. 

In This Article

Abstract and Introduction

The general ophthalmologist is most often the first responder in the care of severe open globe injuries, and in this review, we will outline the current thoughts on assessment and classification of open globe injuries. Basic medical and surgical management issues are reviewed, and relevant controversies and unresolved issues regarding the management of open globe injuries will be discussed.

The management of open globe injuries has evolved over the past 50 years in large part because of technologic advances in anterior and posterior segment surgery. During this time, our understanding of the pathophysiologic processes underlying severe open globe injuries were advanced tremendously by the animal models reported by Ryan, Cleary, and others.[31] These animal models revealed that a predictable series of events occurred following injury as the eye attempts to heal itself. Understanding these processes made it possible to suggest rational therapeutic approaches to counteract the pathologic changes. In the 1990s, attempts were made to standardize terminology and to develop systems to classify open globe injuries, setting the groundwork for future clinical trials in ocular trauma. To date, however, there are relatively few prospective controlled trials in the literature concerning open globe injuries. Clinical recommendations in management are therefore based largely on retrospective reviews and anecdotal evidence. Despite the paucity of formal clinical trials with which to guide clinical decisions, the management of open globe injuries is one of the most challenging and rewarding aspects of ophthalmic care. The physician faced with a severe ocular injury must have an understanding of, and facility with, anterior and posterior segment surgical techniques, as injuries rarely respect the arbitrary divisions of subspecialty training. The physician must be ready to improvise, and the creative mind will find managing these injuries exhilarating.

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