[Management of a ruptured globe]

Area of Science:

• Ophthalmology
• Trauma Surgery

Context:

• Globe rupture is a severe open globe injury with significant risk factors including prior intraocular surgery, myopia, and advanced age.
• Differentiating occult globe rupture from severe ocular contusion can be challenging due to significant subconjunctival hemorrhage and swelling.

Purpose:

• To highlight the diagnostic challenges and critical management steps for globe rupture following blunt ocular trauma.
• To emphasize the importance of timely surgical intervention to prevent severe visual impairment or blindness.

Summary:

• Accurate diagnosis of globe rupture requires limbal and scleral exploration after 360-degree peritomy, especially when differentiating from severe contusion.
• Immediate and watertight wound closure is essential to prevent complications such as expulsive choroidal hemorrhage, ocular hypotony, and epithelial ingrowth.
• Delayed closure increases the risk of posttraumatic endophthalmitis, while early vitrectomy may prevent tractional retinal detachment.

Impact:

• Establishes the critical role of prompt surgical management in preserving vision after globe rupture.
• Provides guidance on diagnostic approaches and essential surgical techniques for managing severe blunt ocular trauma.
• Underscores the potential long-term visual consequences of delayed or inadequate treatment for globe rupture.