Globe Rupture: The Daily PANCE Blueprint
A 41-year-old male presents to the ER after a construction accident which left him with severe right eye pain and decreased visual acuity. On a physical exam, you notice a teardrop-shaped pupil. Which of the following is the most likely diagnosis?
A. Globe rupture
B. Acute angle-closure glaucoma
C. Retinal detachment
D. Corneal laceration
E. Metallic foreign body
Answer and topic summary
The answer is A. Globe rupture
Mechanical globe injuries occur when there is a laceration or full-thickness rupture through the cornea and/or sclera. Globe rupture (also called an open globe) 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). PE signs include subconjunctival hemorrhage, irregularly-shaped pupil, hyphema (anterior chamber bleeding), decreased visual acuity, and limited EOM. This is an emergency and a patient should see an ophthalmologist immediately.
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