Globe ruptureMANAGEMENT

OPHTHALMOLOGIC PRESENTATIONS · 12 SECTIONS

⚲

565 items

☷ Legend

⚲

Cardiovascular Presentations66▾

Respiratory Presentations47▾

Neurological Presentations77▾

Gastrointestinal Presentations63▾

Genitourinary and Reproductive Presentations44▾

Infectious Disease Presentations146▾

Trauma Presentations88▾

Toxicologic Presentations67▾

Psychiatric Presentations25▾

Musculoskeletal and Rheumatologic Presentations89▾

Dermatology Presentations21▾

Environmental and Exposure Presentations26▾

Hematologic and Oncologic Presentations30▾

Pediatric-Specific Presentations13▾

Endocrine and Metabolic Presentations42▾

ENT and Maxillofacial Presentations21▾

Ophthalmologic Presentations15▾

Acute angle-closure glaucoma Central retinal artery occlusion Central Retinal Vein Occlusion Chemical eye injury Corneal abrasion Corneal ulcer Globe rupture Hyphema Iritis-Uveitis Ocular foreign body Optic Neuritis Orbital cellulitis Orbital Floor Fracture (Blowout)Retinal detachment Vitreous Hemorrhage

Obstetric Presentations17▾

Systemic and Miscellaneous Presentations15▾

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

›Cervical spine precautions per mechanism

Red flags and escalation triggers

›High-risk presentation

›Marked decreased vision

›Hand motion or light perception only

›Sudden vision loss after penetrating mechanism

›Severe ocular pain

›Disproportionate pain

›Worsening pain with eye movement

›Teardrop or peaked pupil

›Iris prolapse suspicion

›Full-thickness injury suspicion

›Shallow anterior chamber

›Compared to contralateral eye

›Hypotony association

›Hyphema

›Associated open globe risk

›Secondary bleeding risk

›360-degree subconjunctival hemorrhage

›Occult scleral laceration risk

›Posterior rupture concern

›Extruded uveal tissue

›Brown tissue at wound

›Emergent operative repair indication

›Relative afferent pupillary defect

›Optic nerve or severe retinal injury risk

›Poor prognosis marker

›High-velocity mechanism

›Metal-on-metal

›Projectile and explosion

Immediate contraindications

›Avoidance list

›Tonometry

›IOP elevation risk

›Wound extension risk

›Ocular ultrasound

›Probe pressure risk

›Defer until globe integrity confirmed

›Eye irrigation unless chemical injury

›Pressure risk

›Exception for ongoing alkali or acid exposure

›Foreign body removal outside OR

›Expulsion and hemorrhage risk

›Operative removal preference

›Pressure dressing

›Expulsion risk

›Avoid even with bleeding

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

Symptoms and functional impact

›Symptom characterization

›Visual acuity change

›Baseline vision and eyewear

›Monocular status

›Diplopia

›Orbital fracture concern

›Extraocular muscle entrapment concern

›Flashes or floaters

›Retinal tear or detachment risk

›Vitreous hemorrhage risk

›Nausea and vomiting

›Oculocardiac reflex possibility

›Valsalva risk

›Eye pain severity

›Increasing pain trend

›Pain with movement

Risk factors and modifiers

›Patient factors

›Prior ocular surgery

›Cataract surgery and wound weakness

›LASIK flap considerations

›Contact lens use

›Infection risk

›Corneal findings confounding

›Anticoagulants and antiplatelets

›Bleeding risk

›Hyphema expansion risk

›Immunocompromise

›Infection risk

›Atypical presentations

›Tetanus immunization status

›Booster need

›Immune globulin indications

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

›Avoid forceful testing

›Diplopia pattern

›Orbital fracture clue

›Cranial nerve injury clue

Slit lamp and anterior segment

›Surface and chamber findings

›Corneal laceration

›Seidel test only if minimal manipulation and ophthalmology guidance

›Avoid if obvious open globe

›Shallow anterior chamber

›Asymmetry compared to other eye

›Hypotony association

›Hyphema

›Microhyphema

›Layered hyphema

›Uveal tissue prolapse

›Iris prolapse

›Ciliary body prolapse

›Lens injury

›Traumatic cataract

›Lens dislocation signs

Posterior segment limited assessment

›Fundus limitations

›Gross view only if safe

›Avoid pressure

›Avoid prolonged exam

›Vitreous hemorrhage suspicion

›Poor red reflex

›Sudden vision loss

PITFALLS

›Common errors

›Mislabeling as simple corneal abrasion

›Persistent pain with decreased vision

›High-risk mechanism

›Tonometry performed before excluding open globe

›Vision-threatening complication risk

›Documentation and safety issue

›Eye patching

›Increased pressure risk

›Expulsion risk

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

›Restricted upgaze

›Infraorbital numbness

Mimics and confounders

›Surface injury mimics

›Corneal abrasion

›Pain with preserved vision

›Fluorescein uptake superficial

›Conjunctival laceration

›Localized subconjunctival hemorrhage

›No chamber shallowing

›Traumatic iritis

›Photophobia with ciliary flush

›Cells and flare without full-thickness wound

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

›Sedation planning

›Trauma mechanism clarification

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

›Clinical use

›Counseling and documentation

›Not a delay-to-repair tool

MRI

›MRI considerations

›Avoidance with suspected metallic IOFB

›Migration risk

›Tissue injury risk

›Limited acute role

›CT preferred in acute trauma

›Logistics and time delay

›Selective later use

›Nonmetallic IOFB characterization

›Complex posterior segment evaluation when stable

›CT orbit and head

›Non-contrast CT orbits

›Thin slices 1 mm to 2 mm

›Bone and soft tissue windows

›Key CT findings

›Globe contour abnormality

›Deformity or flattening

›Posterior scleral discontinuity suggestion

›Intraocular air

›Pneumoglobus

›Open globe association

›IOFB identification

›Metallic density

›Glass fragments visibility

›Vitreous hemorrhage density

›Hyperdense vitreous

›Layering or clot

›Orbital fractures

›Blowout fracture

›ZMC fracture

›CT limitations

›Normal CT does not exclude open globe

›Small lacerations missed

›Clinical suspicion predominance

›Sensitivity variability

›Operator and protocol dependence

›Posterior rupture detection limits

›Guideline framing

›High clinical suspicion warrants ophthalmology involvement regardless of imaging (ACEP Level C consensus-style)

Ultrasound

›Ultrasound role

›Avoidance in suspected open globe

›Probe pressure risk

›Expulsion risk

›Conditional use after globe integrity confirmed

›Retinal detachment evaluation

›Vitreous hemorrhage evaluation

›POCUS pearls when allowed

›Minimal pressure technique

›Copious gel mound

›Hand braced on bony orbit

›Signs

›Retinal detachment membrane

›Vitreous debris

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

›Ceftazidime IV 2 g

›Frequency every 8 hours

›Renal adjustment as needed

›Coverage intent

›Gram-positive including staphylococci

›Gram-negative including Pseudomonas

›Alternative IV regimen when ceftazidime contraindicated

›Vancomycin IV 15 mg/kg

›Same dosing principles

›Monitor infusion reaction

›Ceftriaxone IV 2 g

›Frequency every 24 hours

›Limited Pseudomonas coverage

›Oral option in selected lower-risk cases per ophthalmology

›Levofloxacin PO 750 mg

›Frequency daily

›Tendinopathy risk counseling

›Moxifloxacin PO 400 mg

›Frequency daily

›QT risk consideration

›Timing principle

›Initiate as early as feasible when open globe suspected

›Do not delay for imaging when clinical signs strong (Class I style consensus)

Tetanus prophylaxis

›Immunization management

›Tdap or Td booster

›Indicated if last dose more than 5 years for dirty wound

›Indicated if unknown or incomplete series

›Tetanus immune globulin

›Indicated for unknown or incomplete immunization with contaminated wound

›Separate injection site from vaccine

Operative and ophthalmology-directed therapies

›Specialist-led components

›Primary globe repair

›Corneal or scleral closure

›Uveal tissue repositioning decisions

›Intravitreal antibiotics when indicated

›High contamination risk

›Suspected endophthalmitis

›Corticosteroids selective use

›Inflammation control

›Infection exclusion priority

›Cycloplegia and topical therapies

›Iritis control when appropriate

›Avoid topical pressure increasing maneuvers

What to avoid

›Harm reduction

›Topical drops requiring pressure

›Avoid forced eyelid opening

›Avoid manipulation until protected

›Nasal positive pressure devices when facial fractures suspected

›Orbital emphysema risk

›Worsening orbital pressure risk

›Succinylcholine during induction when alternatives available

›IOP rise concern

›Anesthesia team decision-making

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

›Anxiety and cooperation barriers

›Early procedural sedation coordination

›Weight-based dosing

›Vancomycin IV 15 mg/kg

›Dosing interval per age and renal function

›Infusion reaction monitoring

›Ceftazidime IV 50 mg/kg

›Max single dose 2 g

›Frequency every 8 hours typical

›Non-accidental trauma consideration

›Inconsistent history

›Additional injury screening

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

›Rare but vision-threatening

Therapeutic Considerations

›Why key treatments matter

›Shielding

›Prevents inadvertent pressure

›Reduces further extrusion risk

›Antiemesis and analgesia

›Reduces Valsalva and squeezing

›Reduces secondary expulsion risk

›Early antibiotics

›Endophthalmitis prevention goal

›Broader coverage for contaminated wounds

›Timely surgical closure

›Restores globe integrity

›Reduces infection and tissue prolapse risk

›Evidence framing

›Antibiotic prophylaxis and early repair supported by expert consensus and observational data (ACEP Level C style, Class I style consensus)

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

Learn More: Globe rupture→

Comprehensive Clinical Review

Structured, evidence-informed, long-form analysis for deeper understanding.

Evidence & Review

Reviewed by SymptomDx Medical Team · Last reviewed June 16, 2026

SymptomDx is an educational tool for medical professionals. It does not replace clinical judgment. Verify all clinical data and drug dosages with authoritative sources.