Open Globe Injury

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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

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