Common Ophthalmic Emergencies

G. D. Khare; R. C. Andrew Symons; D. V. Do


Int J Clin Pract. 2008;62(11):1776-1784. 

In This Article


Ruptured Globe

A ruptured globe from a penetrating ocular injury usually presents with decreased vision, subconjunctival haemorrhage, hyphema and irregular shaped pupil. A traumatic cataract and full-thickness scleral or corneal lesion may also be present. The lens may become subluxed and vitreous haemorrhage may also be present.

A patient with a ruptured globe with penetrating ocular injury should be immediately seen by an ophthalmologist because urgent surgical repair is often required.[9] Prior to surgery, the eye should be protected with a shield and systemic antibiotics should be given as soon as possible (cefazolin with moxifloxacin for adults and cefazolin with gentamicin for children under 12 years). Tetanus toxoid should be administered and an anti-emetic should be used pro re nata to reduce the risk of expulsive haemorrhage. CT of the orbits and brain is necessary to localise injuries, rule out foreign bodies and plan surgical repair. B-scan ultrasound should be avoided in the setting of a ruptured globe, as the injury could be made significantly worse from the pressure of the ultrasound probe.

Intraocular Foreign Body

Some intraocular foreign bodies can be very difficult for the non-ophthalmologist to detect on examination. The occurrence of any ocular problem following striking metal upon metal should lead to referral to an ophthalmologist even if the examination appears normal. Examination should be performed to assess visual acuity, the foreign body's entry site, whether the entry wound is self-sealing or still leaking, whether there is any prolapse of intraocular tissue and the extent of damage to the globe, especially to the lens and retina. An iris transillumination defect should alert the examiner to the possible presence of an intraocular foreign body in the posterior segment. Pupil irregularity or the presence of hyphema or vitreous haemorrhage are other clues. CT scanning with 1 mm or finer cuts and B-sound ultrasonography are the best imaging modalities for the detection of foreign bodies.

If visible, penetrating foreign objects should not be removed immediately so as to avoid extrusion of intraocular contents. Any intraocular foreign body will require removal by an ophthalmologist, and in the case of posterior segment foreign bodies, the expertise of a vitreo-retinal surgeon is required. Prior to surgery, a shield should protect the eye, and tetanus prophylaxis, intravenous antibiotics (generally vancomycin and ciprofloxacin), and a cyclopegic should be given.


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