Open Globe Injuries

Clinical Description

Laceration on the cornea or sclera

Signs and Symptoms

• History of injury (always ascertain the mode of injury), reduction/loss of vision following trauma, bleeding from the eye, severe pain, tearing and sensitivity to light, the feeling that there is something in the eye
• Obvious corneal laceration visible on direct light
• Prolapsed iris can be seen plugging the laceration
• Peaked pupil
• Subconjunctival hemorrhage/hematoma whose posterior limits cannot easily be delineated
• Anterior chamber is flat +/- hyphema
• Eyeball is soft

Investigations

• Examine under topical anesthetic eye drops, gently examine the eye under full aseptic conditions. The laceration will be visible.

Treatment

• Management before referral to a treating centre
• Tetanus Toxoid (TTV) 0.5ml IM STAT
• Place plastic shield on affected eye
• Ceftriaxone 2g IV STAT or Ciprofloxacin 500mg PO 12 hourly for 5 days
• Give analgesic but preferably avoid NSAIDs to prevent worsening the bleeding

Complications

• Retinal detachment
• Endophthalmitis
• Glaucoma
• Traumatic cataract
• Blindness

Complications and Referral Criteria

• Refer ALL cases to a treating center