Open Globe Management

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


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

In This Article

General Evaluation

In the setting of eye trauma, it is important to assess the whole patient, keeping in mind that the person may have also sustained nonocular injuries (e.g., occult stab/gunshot wound, fracture, closed head trauma) that may be life threatening and must be addressed first.

On intake, vital signs should be recorded along with an assessment of the patient’s mental status. The patient should be examined for evidence of obvious bone or severe soft-tissue injury before concentrating on the eye, and if an injury to another organ is suspected, the patient should be referred to a trauma center for initial triage.

In a study to determine the type and frequency of ocular injuries in patients with major trauma, 16% of the major trauma cohort had ocular or orbital trauma. Of patients with injuries involving the face, 55% had ocular or orbital injuries.[5] Another study found the incidence of ocular injuries in patients with major trauma was lower (2.3%), but considerable association was found between eye injuries and facial fractures.[6] Once it is determined that the patient’s general condition is stable, a more general medical/surgical history should be taken, documenting all medical conditions, prior surgeries, drug allergies, a history of any complications during anesthesia, current medications, the time when the patient last ate or drank, and tetanus immunization status (toxoid is recommended in all cases of open globe injury when immunization is not up to date or when an adequate vaccination history cannot be obtained).

The elderly and children deserve special considerations. Falls are among the most frequent causes of eye and orbital trauma in the elderly population, and falls can be associated with other fractures. If the patient is anticoagulated, such injuries could be life-threatening. Obtaining a reliable history from a child or an elderly patient may be difficult or impossible. The inability for the ophthalmologist to perform an adequate examination in the office should prompt the scheduling of an examination under anesthesia. In children or the elderly, one should always consider the possibility of abuse.

A detailed history of the eye injury is one of the most important aspects of patient evaluation. Knowing the type of injury (blunt vs. penetrating), the nature of the penetrating material (metal, nail, wood), and the setting (work, home, etc.) will allow the physician to make risk assessments for the possibility of unsuspected or occult globe injury, such as globe perforation, posterior scleral rupture, intraocular foreign bodies (IOFBs), chemical exposure, or microbial contamination.


Comments on Medscape are moderated and should be professional in tone and on topic. You must declare any conflicts of interest related to your comments and responses. Please see our Commenting Guide for further information. We reserve the right to remove posts at our sole discretion.