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Grossing of Non-neoplastic Globes, Including Fetal Eyes

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The Ruptured Globe, Sympathetic Ophthalmia, and the 14-Day Rule.

David R Jordan¹, Jonathan J Dutton²

¹Department of Ophthalmology, University of Ottawa and the Ottawa Hospital, Ottawa, Ontario, Canada.

Ophthalmic Plastic and Reconstructive Surgery

|October 1, 2021

Summary

The 14-day rule for removing a severely injured eye to prevent sympathetic ophthalmia (SO) lacks scientific support. Current evidence suggests saving the ruptured globe is preferable, as SO is rare and treatable, and prophylactic enucleation has risks.

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Area of Science:

Ophthalmology
Trauma Surgery
Immunology

Background:

Prophylactic enucleation of globe rupture within 14 days to prevent sympathetic ophthalmia (SO) is a long-standing teaching.
This practice lacks scientific validation and is based on historical speculation.
Modern microsurgical techniques offer better repair options for open globe injuries.

Purpose of the Study:

To review the current understanding of globe rupture and SO.
To examine the origin and scientific validity of the 14-day rule for enucleation.
To emphasize the importance of attempting to save traumatized eyes.

Main Methods:

Comprehensive literature review on sympathetic ophthalmia and globe rupture.
Analysis of historical and current treatment strategies.
Evaluation of the risks and benefits of prophylactic enucleation versus globe salvage.

Main Results:

Sympathetic ophthalmia is a rare complication of globe rupture and intraocular surgery.
SO can occur even after timely enucleation; new treatments are available.
Retaining the injured eye avoids psychological distress and phantom phenomena associated with enucleation.
The risk of SO following evisceration or enucleation is exceedingly low.

Conclusions:

The 14-day rule for prophylactic enucleation is not scientifically supported.
Every effort should be made to repair open globe injuries, even severe ones.
Saving the ruptured globe is advocated due to the low risk of SO and availability of new treatments.
Evisceration is a viable alternative to enucleation when malignancy is absent.