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Suspected Hidden Rupture
- Seidel test positive? Asymmetric anterior chamber? Asymmetric intraocular pressure?
Suspected Intraocular Foreign Body
- High-resolution (thin cuts) CT orbit
- Antibiotic coverage with oral Ciproxin (ciprofloxacin) p.o. 2x500mg/d 7-14days and Floxal (ofloxacin) gtt 3x/d
- If intraocular foreign body is detected or highly suspected (appropriate trauma, foreign body may not be visible in CT scan)
- Consider (diagnostic) Pars Plana Vitrectomy (PPV)
- Check tetanus vaccine!
Open Globe Injury
- Large wounds
- examine with a flashlight/slit lamp
- No pressure on the eye
- Limit examination to the essentials once clinically confirmed
- Small wounds
- Seidel test positive? Asymmetric anterior chamber? Asymmetric intraocular pressure?
- Use protective eye cover! No bandaging on the eye
- If suspected intraocular foreign body, CT scan of the orbit (as above)
- Check tetanus vaccine!
- Administer antiemetics (e.g., Ondansetron 4mg) to prevent expulsion of intraocular tissue (when vomiting)
- Systemic antibiotics within 6 hours of injury
- Bed rest, no exertion, no valsalva manoever!
- Operative care as soon as possible (even at night!)
- Goal: Primary closure of the eye
- Always attempt to reposition prolapsed tissue, remove necrotic material if necessary
Sources
- EyeWiki Ocular penetrating and perforating injuries
- EyeWiki Ruptured Globe
- AAO 8 Pearls in Evaluating and Managing Open Globe Injuries
- The Wills Eye Manual: Office and Emergency Room Diagnosis and Treatment of Eye Disease; Nika Bagheri MD, Brynn Wajda MD, et al; Lippincott Williams&Wilkins; 7th Edition (2016)
- Kanski’s Clinical Ophthalmology: A Systematic Approach; Jack J. Kanski MD, Brad Bowling MD; Saunders Ltd.; 8th Edition (2015)