Globe Rupture: The Daily PANCE Blueprint

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Globe Rupture: The Daily PANCE Blueprint

A 30-year-old construction worker presents to the emergency department after a metal fragment hit his right eye while hammering a nail. He complains of severe pain and decreased vision in the affected eye. On examination, you notice a teardrop-shaped pupil and a shallow anterior chamber in the right eye. There is no evidence of a foreign body on the surface of the eye. His left eye examination is unremarkable. What is the most appropriate next step in the management of this patient?

A. Immediate administration of topical anesthetic and fluorescein dye to assess for corneal abrasion
B. Placement of an eye shield over the right eye and urgent ophthalmology consultation
C. Administration of intravenous antibiotics and immediate CT scan of the orbits
D. Application of a pressure patch over the right eye and referral for outpatient ophthalmology follow-up
E. Immediate irrigation of the right eye with saline solution and topical antibiotic application

Answer and topic summary

The answer is B. Placement of an eye shield over the right eye and urgent ophthalmology consultation

This patient’s presentation is highly suggestive of an open globe injury, indicated by the teardrop-shaped pupil and shallow anterior chamber. In such cases, the most appropriate initial management is to protect the eye from further injury by placing an eye shield over the affected eye and arranging for an urgent ophthalmology consultation. Any manipulation of the eye, including intraocular pressure measurement, should be avoided to prevent further damage or extrusion of intraocular contents.

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Covered under ⇒ PANCE Blueprint EENT ⇒ Traumatic disorders ⇒ Globe rupture