Globe ruptureMANAGEMENT

OPHTHALMOLOGIC PRESENTATIONS · 12 SECTIONS

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565 items

☷ Legend

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Cardiovascular Presentations71▾

Respiratory Presentations52▾

Neurological Presentations83▾

Gastrointestinal Presentations74▾

Genitourinary and Reproductive Presentations48▾

Infectious Disease Presentations148▾

Trauma Presentations89▾

Toxicologic Presentations80▾

Psychiatric Presentations26▾

Musculoskeletal and Rheumatologic Presentations96▾

Dermatology Presentations23▾

Environmental and Exposure Presentations27▾

Hematologic and Oncologic Presentations36▾

Pediatric-Specific Presentations19▾

Endocrine and Metabolic Presentations45▾

ENT and Maxillofacial Presentations27▾

Ophthalmologic Presentations19▾

Acute angle-closure glaucoma Central retinal artery occlusion Central Retinal Vein Occlusion Chemical eye injury Corneal abrasion Corneal ulcer Endophthalmitis Globe rupture Herpes zoster ophthalmicus Hyphema Iritis-Uveitis Ocular foreign body Optic Neuritis Orbital cellulitis Orbital Floor Fracture (Blowout)Posterior vitreous detachment Retinal detachment Retrobulbar hematoma and orbital compartment syndrome Vitreous Hemorrhage

Obstetric Presentations23▾

Systemic and Miscellaneous Presentations17▾

01Approach to the Critical Patient/attcp72

Immediate priorities

›Time-critical stabilization

›Eye shield rigid

›No patching

›No pressure on globe

›NPO status

›Anticipated operative repair

›Aspiration risk reduction

›Analgesia

›Avoid agitation and Valsalva

›Hemodynamic stability during pain control

›Antiemesis

›Vomiting and Valsalva risk

›Reduced intraocular content extrusion risk

›Head-of-bed elevation

›Edema reduction

›Comfort

›Tetanus prophylaxis

›Contaminated wound assumption

›Update per immunization status

›Immediate ophthalmology consultation

›Suspected open globe as surgical emergency

›Transfer trigger if no on-call coverage

›Broad-spectrum IV antibiotics initiation

›Endophthalmitis prophylaxis

›Start prior to transfer when indicated

›Concomitant trauma evaluation

›Head and facial trauma frequency

02History/hx58

Presentation profile

›Clinical vignette

›Sudden ocular pain and vision loss after trauma

›Penetrating injury mechanism

›Blunt injury with facial impact

›Eye shape change sensation

›Soft eye sensation

›Fluid leakage sensation

›Photophobia and tearing

›Anterior segment irritation

›Associated corneal injury

Mechanism and timing

›Injury context

›Time of injury

›Time-sensitive repair planning

›Infection risk progression

›Blunt trauma details

›Fist, ball, fall, MVC airbag

›Suspected posterior globe rupture

›Penetrating trauma details

›Knife, glass, metal fragment

›Wound contamination likelihood

›High-velocity risk

›Hammering, grinding, drilling

›Intraocular foreign body probability

›Chemical exposure

›Alkali or acid

›Irrigation priority if ongoing exposure

03Physical Exam/exam63

General and periocular exam

›External survey

›Periorbital lacerations

›Lid margin involvement

›Canalicular injury concern

›Periorbital ecchymosis and edema

›Orbital fracture association

›Baseline exam limitations

›Facial step-offs

›ZMC fracture concern

›Orbital rim instability

›Proptosis

›Orbital compartment syndrome concern

›Retrobulbar hemorrhage concern

Eye exam without pressure

›Vision and pupils

›Visual acuity best-corrected

›Pin-hole if tolerated

›Document pre-op baseline

›Pupillary size and reactivity

›Peaked pupil sign

›Anisocoria documentation

›Relative afferent pupillary defect

›Optic nerve injury clue

›Severe retinal injury clue

›Ocular alignment and motility

›Extraocular movements gentle

›Entrapment concern with pain

04Differential Diagnosis/ddx39

Vision-threatening differentials

›Open globe spectrum

›Rupture of globe (ICD-10 S05.3)

›Blunt mechanism typical

›Scleral laceration posterior risk

›Penetrating injury with full-thickness laceration (ICD-10 S05.6)

›Sharp object mechanism

›Seidel positive possibility

›Intraocular foreign body (ICD-10 S05.5)

›High-velocity mechanism

›Metallic fragment risk

›Closed globe but urgent

›Orbital compartment syndrome

›Proptosis with tight orbit

›Vision loss and RAPD

›Retrobulbar hematoma

›Increasing pain and proptosis

›Decreased vision progression

›Retinal detachment

›Flashes and floaters

›Curtain-like vision loss

›Traumatic hyphema without rupture

›Microhyphema

›Elevated IOP risk if closed globe

›Lens dislocation

›Iridodonesis

›Monocular diplopia

›Orbital blowout fracture

05Laboratory Tests/lt27

Baseline and pre-op testing

›Preoperative readiness

›Complete blood count

›Bleeding concern

›Baseline anemia assessment

›Electrolytes and renal function

›Contrast planning for CT if needed

›Medication dosing support

›Coagulation profile

›Warfarin or liver disease concern

›Surgical planning support

›Type and screen

›Operative planning

›Significant hemorrhage risk scenarios

Infection and contamination considerations

›Infection risk modifiers

›Blood glucose

›Diabetes screening support

›Infection risk correlation

›Wound contamination documentation

›Soil exposure

›Farm injury exposure

Point-of-care adjuncts

›Bedside support

›Pregnancy test when applicable

›Imaging planning

›Medication safety planning

›Ethanol level when relevant

06Diagnostic Tests/dt83

Scoring Systems

›Prognosis and classification tools

›Birmingham Eye Trauma Terminology System (BETTS)

›Open globe injury definition

›Full-thickness wound of cornea or sclera

›Laceration vs rupture

›Rupture

›Blunt trauma mechanism

›Inside-out failure at weakest point

›Laceration

›Outside-in full-thickness wound

›Penetrating vs perforating

›Intraocular foreign body category

›Open globe with retained IOFB

›Metallic vs organic risk differences

›Ocular Trauma Score (OTS)

›Baseline visual acuity category

›No light perception

›Light perception or hand motion

›Counting fingers to 20/200

›20/200 to 20/50

›20/40 or better

›Adverse prognostic factors

›Globe rupture

›Endophthalmitis

›Perforating injury

›Retinal detachment

›Relative afferent pupillary defect

07Disposition/dispo26

Level of care and transfer

›Disposition pathways

›Emergent ophthalmology surgical management

›Operative repair planning

›Endophthalmitis prevention priority

›Admission criteria

›All suspected or confirmed open globe

›Need for IV antibiotics or operative repair

›Transfer criteria

›No ophthalmology coverage

›No operative capability

›Transport precautions

›Eye shield maintained

›Avoid lying flat when possible

›Timing considerations

›Repair generally within 24 hours when feasible

›Earlier repair when contaminated wound or tissue prolapse

Monitoring and perioperative planning

›In-hospital management needs

›Pain and nausea control

›Prevent Valsalva

›Prevent agitation

›Antibiotic continuation

›IV regimen completion per ophthalmology

›Transition to oral when appropriate

›NPO maintenance

›OR scheduling variability

›Aspiration risk reduction

08Treatment/t79

Eye protection and supportive care

›Protection and physiology

›Rigid eye shield

›Continuous use

›Removal only by ophthalmology

›Activity restrictions

›Bedrest or limited ambulation

›Avoid bending and straining

›Antiemesis strategy

›Ondansetron IV 4 mg

›Repeat 4 mg every 6 hours as needed

›Max daily dose per local policy

›Metoclopramide IV 10 mg

›Alternative agent

›Avoid in significant QT prolongation risk

›Analgesia strategy

›Fentanyl IV 25 mcg to 50 mcg

›Titration 25 mcg every 5 minutes to comfort

›Respiratory monitoring

›Hydromorphone IV 0.2 mg to 0.5 mg

›Titration 0.2 mg every 10 minutes

›Geriatric dose reduction consideration

Antibiotics for endophthalmitis prophylaxis

›Systemic prophylaxis

›Preferred IV regimen for high-risk open globe

›Vancomycin IV 15 mg/kg

›Max single dose 2 g

›Infusion time at least 60 minutes

09Special Populations/sp37

Pregnancy

›Pregnancy considerations

›Imaging safety

›CT orbit radiation localization

›Shielding and dose minimization

›Medication selection

›Ondansetron risk-benefit discussion

›Avoid tetracyclines and aminoglycosides when alternatives exist

›Antibiotic choices

›Cephalosporins generally compatible

›Fluoroquinolones risk-benefit individualized

›Obstetric coordination

›Viability and fetal monitoring when trauma significant

›Rh status considerations when abdominal trauma present

Geriatric

›Older adult considerations

›Anticoagulation and antiplatelet use

›Coagulopathy reversal planning with trauma team

›Increased hemorrhage risk

›Medication sensitivity

›Opioid dose reduction

›Delirium risk with sedatives

›Prior ocular surgery

›Pseudophakia vulnerability

›Occult rupture with mild external signs

Pediatrics

›Pediatric considerations

›Examination limitations

10Background/b42

Epidemiology

›Population patterns

›Ocular trauma burden

›Common cause of monocular vision loss

›Male predominance in many cohorts

›Mechanism distribution

›Blunt trauma in sports and falls

›Penetrating trauma in work-related metal-on-metal

›High-risk contexts

›No eye protection in grinding or hammering

›Assault-related facial trauma

Pathophysiology

›Injury mechanics

›Rupture mechanism

›Sudden IOP spike after blunt impact

›Failure at weakest scleral point

›Laceration mechanism

›Sharp object full-thickness cut

›Direct uveal exposure risk

›Complication pathways

›Endophthalmitis

›Microbial inoculation at time of injury

›Delayed presentation risk

›Retinal detachment

›Vitreoretinal traction after trauma

›Progressive vision loss risk

›Sympathetic ophthalmia

›Autoimmune bilateral uveitis risk

11Patient Discharge Instructions/pdi22

copy discharge instructions

›Transfer and post-repair instructions

›Eye shield at all times

›No rubbing or pressure

›No patching under shield

›NPO until cleared

›Pending surgery or transfer

›Aspiration risk reduction

›Activity restrictions

›No heavy lifting

›No bending or straining

›Medication adherence when prescribed

›Antibiotics exactly as directed

›Antiemetics for nausea prevention

›Return to ED immediately for

›Worsening vision

›Increasing eye pain

›New nausea or vomiting

›Bleeding from eye

›Fever or systemic illness symptoms

›Follow-up and timing

›Ophthalmology follow-up as scheduled

›Same-day evaluation if any red flags

12References/r17

Clinical guidelines and core sources

›Core guidance

›American Academy of Ophthalmology guidance on open globe injury evaluation and management

›Eye shield and avoidance of tonometry

›Urgent ophthalmology consultation and repair

›Birmingham Eye Trauma Terminology System (BETTS)

›Standard terminology for rupture and laceration

›Communication and documentation standardization

›Ocular Trauma Score (OTS)

›Prognostication framework

›Counseling support

›Evidence-based reviews

›Reviews on systemic antibiotic prophylaxis for open globe injuries and endophthalmitis prevention

›Broad-spectrum coverage rationale

›Timing and contamination risk factors

›Imaging reviews for ocular trauma

›CT orbit protocols

›IOFB detection considerations

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Reviewed by SymptomDx Medical Team · Last reviewed August 18, 2026

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