Globe Rupture: The Daily PANCE Blueprint
A 40-year-old male is struck in the eye during an assault. He has severe eye pain, decreased vision, a teardrop-shaped pupil, and hyphema. Which of the following is the next best step in management?
A. Check intraocular pressure
B. Apply a pressure patch
C. Emergent ophthalmology consultation
D. Irrigate the eye only
E. Start fluids and antibiotics
Answer and topic summary
The answer is C. Emergent ophthalmology consultation
Mechanical globe injuries occur when there is a laceration or full-thickness rupture through the cornea and/or sclera. Globe rupture (also called open globe rupture) follows blunt eye injury (e.g., motor vehicle crash, assault, thrown ball, etc). Globe lacerations occur after trauma from a sharp-penetrating object (e.g., knife or high-velocity projectile). Physical exam signs include subconjunctival hemorrhage, irregularly-shaped pupil, foreign body, hyphema (anterior chamber bleeding), decreased visual acuity, and limited EOM. This is an emergency, and the patient should see an ophthalmologist immediately.
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