One day after he had been hit in the left eye with a drinking glass, a 48-year-old man sought medical attention. He could see only light and shadows with the eye.
The patient's last eye examination was 4 years earlier; he wore reading glasses. He took 2 adult aspirins daily for muscle aches. His ocular and medical histories were otherwise unremarkable.
Multiple small lacerations were noted on the forehead, nose, eyelids, and periorbita. Many were secured with glue, which the patient had applied as self-treatment. A 45-mm, partial-thickness laceration extended from the left upper eyelid through the left eyebrow laterally. No foreign bodies were identified. Ecchymosis and edema with traumatic eyelid ptosis were also present.
Vision in the left eye consisted of light perception. Significant conjunctival edema and subconjunctival hemorrhage were apparent. Slit lamp evaluation showed a 30% layered hyphema and corneal edema; corneal blood staining obscured pupil and iris detail. The anterior chamber appeared shallow, but there were no corneal lacerations. Extraocular motility seemed intact.
A noncontrast CT scan of the orbits showed posterior dislocation of the left lens into the vitreous cavity; the lens lay on the retinal surface. The significant eye wall deformity suggested globe rupture. Posteriorly, a high-attenuation interface was visible; this indicates possible retinal detachment and hemorrhage within the potential subretinal space between the choroid and retina. No fractures were noted.
The eyelid-eyebrow laceration was repaired. Exploration of the globe during surgery confirmed 2 separate scleral rupture sites, which were also repaired. The patient was scheduled for a retinal consultation for vitrectomy, lensectomy, and possible retinal detachment repair.
Patients with serious eye injuries should be immediately referred to an ophthalmologist. Taping a metal or plastic shield over the injured eye prevents manipulation of the eye by the patient and minimizes further damage. An eye patch should not be applied, because it places pressure on the globe and could lead to the extrusion of intraocular contents.
If imaging is necessary, a noncontact CT scan of the orbits is preferred. CT scanning is rapid and has no direct contact with the eyelids or globe. It details the ocular structure well, identifies the size and location of any intraocular foreign body, and detects fractures. The specificity of CT in the detection of open-globe injury is 95%.1
1. Joseph DP, Pieramici DJ, Beauchamp NJ. Computed tomography in the diagnosis and prognosis of open-globe injuries. Ophthalmology. 2000;107:1899-1906.