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Managing Ocular Trauma
Published in Amy-lee Shirodkar, Gwyn Samuel Williams, Bushra Thajudeen, Practical Emergency Ophthalmology Handbook, 2019
The first step is to measure and record visual acuity and record the presence or absence of an RAPD. If you suspect globe rupture, it is important to use minimal pressure whilst examining the eye as this could further expel intraocular contents. Slit lamp findings can be categorised into anterior and posterior segment signs. Remember to examine both eyes, documenting the time and date you started and finished your examination. Be as detailed as you can in case you are requested further down the line to produce a police report. This is not an infrequent occurrence at all.
Suprachoroidal hemorrhage
Published in A Peyman MD Gholam, A Meffert MD Stephen, D Conway MD FACS Mandi, Chiasson Trisha, Vitreoretinal Surgical Techniques, 2019
Uday R Desai, Alexander Rubowitz
Expulsive hemorrhage is defined as suprachoroidal hemorrhage with associated expulsion of intraocular contents. Although this complication may occur in cases of traumatic globe rupture, we will limit our discussion here to cases occurring during intraocular surgery. Because the incidence of expulsive hemorrhage is low,17,26,27,43–;46 and has possibly even been lowered recently due to better surgical instrumentation and techniques,47 the surgeon may not be prepared for its occurrence. This may be another reason why these cases have such an unfavorable prognosis.
Scleral laceration
Published in Alisa McQueen, S. Margaret Paik, Pediatric Emergency Medicine: Illustrated Clinical Cases, 2018
Lacerations to the cornea or sclera can occur following trauma by a sharp object, projectile, or by blunt trauma. The clinician should consider the possibility of a retained foreign body. Delayed presentation increases the risk of infection. Previous visual acuity should be considered. The presence of 360° subconjunctival hemorrhage, impaired extraocular movements, volume loss to the eye, decreased visual acuity, or hyphema may indicate globe rupture.
Open Globe Injuries with Concurrent Orbital Fractures – Clinical Settings and Factors Predicting Outcomes
Published in Seminars in Ophthalmology, 2023
Tarjani Vivek Dave, Prapti Praful Chheda, Anthony Vipin Das, Vivek Pravin Dave
The current study reports the outcome cases with open globe injuries with concurrent orbital fractures and how the associated fractures have an effect on the final outcomes. We noted that the presence of a concurrent retinal detachment with an orbital fracture is the single most important determinant for both poor functional and anatomic outcomes. Further favorable anatomic outcome for an open globe injury with orbital fracture was determined by absence of zone 3 involvement of the globe, absence of orbital rim involvement by the fracture and absence of more than one orbital wall fracture. Like most cases of trauma around the world, the young population was mainly involved in this cohort too. Males accounted for over 80% of the cases in the current cohort. This is in agreement with other large studies of concurrent orbito-facial fractures and globe injury.15,16 In general, the most common type of open globe injury as per BETT is penetrating injury.11 In the current study, globe rupture was the most predominant type of injury instead of a penetrating one (67%). In another large study on concomitant open globe injuries and orbital fractures also, a globe rupture was the commonest type of globe injury noted (82.8%).15 Patients with an open globe injury with orbital fracture were also more likely to have sustained a mechanical fall or an assault and were less likely to have been injured by a projectile. This explains the higher incidence of globe rupture over a penetrating injury.
Radiological findings of orbital blowout fractures: a review
Published in Orbit, 2021
Ma ReginaPaula Valencia, Hidetaka Miyazaki, Makoto Ito, Kunihiro Nishimura, Hirohiko Kakizaki, Yasuhiro Takahashi
Globe rupture is a serious complication after blunt facial trauma. This is less common in patients with orbital blowout fracture because as previously mentioned, pressure onto the globe at the moment of impact with a material escapes through the fracture site.10,45 A recent study demonstrated that 1 of 73 patients with orbital fracture who were referred to a level I trauma centre had globe rupture.59 In patients with orbital fracture, the site of globe rupture is usually located at the posterior segment, as opposed to patients with globe rupture alone (without orbital fracture) wherein the site of rupture is usually the anterior segment.60 The globe rupture presents a contour deformity of the globe on imaging (Figure 5h); however, as the severity of ocular soft tissue damage, including globe injuries, tend to be underestimated from radiological signs, ophthalmologists need slit-lamp and funduscopic examinations of the affected eyes.14
Dog bite injuries of the eye and ocular adnexa
Published in Orbit, 2019
Benjamin P. Erickson, Paula W. Feng, Sophie D. Liao, Yasha S. Modi, Audrey C. Ko, Wendy W. Lee
Fortunately, the eye itself is very rarely damaged, with only a small handful of cases reported in the literature.18,27 The blink reflex typically protects the globe, which is retropulsed into the orbit and spared from direct trauma.27 Unusual circumstances appear to be necessary for globe rupture to occur. Habot-Wilner and colleagues speculate that a 23-year-old victim who sustained a corneal laceration and mild traumatic cataract either had a delayed blink reflex or was bitten so unexpectedly that the lids could not close in time to protect the globe.27 Jones reported two cases resulting in scalp wounds and complex corneoscleral perforations; he postulated that the upper canine teeth acted as a fulcrum on the cranium, permitting the lower canines to enter the inferomedial orbit and perforate the globe.18