A deflated eyeball is a non-medical term for a severe eye injury where the eye loses its normal shape and pressure. Medically, it’s often called a “ruptured globe” in acute trauma or “phthisis bulbi” for an end-stage, shrunken, non-functional eye. This condition is a profound ocular emergency requiring immediate medical attention, as it indicates extensive damage that can lead to permanent vision loss.
Causes of a Deflated Eyeball
The most common cause of a deflated eyeball, or ruptured globe, is physical trauma. This can result from a penetrating injury, where a sharp object like glass or metal pierces the eye, or from severe blunt force. Blunt trauma, often from falls, motor vehicle accidents, or assaults, can cause the eye’s internal pressure to rise sharply. This leads to a tear in the sclera, the eye’s outer white layer, often at its weakest points near the rectus muscles.
Less commonly, complications from complex eye surgeries can also lead to a globe rupture. Procedures like large incision cataract removal, corneal transplants, or glaucoma filtering surgeries can compromise the eye’s structural integrity, making it more vulnerable to collapse.
Advanced, uncontrolled eye diseases are another cause, leading to phthisis bulbi. End-stage glaucoma, for example, can cause sustained low intraocular pressure (hypotony), leading to eye shrinkage. Severe intraocular infections (endophthalmitis), recurrent retinal detachment, and uveitis (long-term eye inflammation) can also weaken internal structures, causing eventual collapse. Autoimmune disorders causing chronic eye inflammation can also contribute to this process.
Identifying the Signs and Symptoms
Recognizing the signs of a deflated eyeball is important, as prompt medical attention can influence outcomes. A noticeable change in the eye’s shape, appearing shrunken, collapsed, or visibly misshapen, directly indicates structural damage. This is often accompanied by severe pain in and around the affected eye.
Sudden, profound vision loss in the affected eye is common, as the injury impacts light processing. Fluid may also leak from the eye, such as vitreous fluid or aqueous humor. The pupil may appear irregularly shaped, often peaked or tear-drop shaped, due to iris damage.
Other signs include hyphema (blood in the front of the eye) and extensive subconjunctival hemorrhage, where blood collects under the clear membrane covering the white of the eye, giving it a deep red appearance. Swelling and redness around the eye are common inflammatory responses. Eyelids may be difficult to open or appear “glued” shut, and the eye might feel soft to the touch.
Medical Intervention and Treatment
Immediate medical intervention is imperative upon suspicion of a deflated eyeball. Diagnosis begins with an emergency eye examination by an ophthalmologist, focusing on visual acuity and careful inspection using a slit lamp to identify lacerations, foreign bodies, or changes in internal structures. Imaging studies, particularly a non-contrast maxillofacial CT scan, assess damage, detect intraocular foreign bodies, and identify altered globe contours or decreased anterior chamber depth. To avoid further damage, maneuvers that could increase eye pressure, such as applying direct pressure or using tonometry, are avoided if a rupture is evident.
Immediate treatment goals are to protect the eye, prevent infection, and manage pain. Patients are advised to refrain from eating or drinking before surgery. A rigid eye shield is placed over the affected eye to prevent external pressure or contact that could extrude internal contents. Antiemetics help prevent vomiting, which can increase intraocular pressure, while pain medications manage discomfort.
Surgical repair is the primary emergency treatment for a ruptured globe. The surgeon aims for immediate, watertight wound closure to prevent complications like severe internal bleeding (choroidal hemorrhage) and infection (endophthalmitis). Prophylactic intravenous antibiotics are administered to reduce infection risk, and tetanus immunization status is also addressed. Ideally, surgery occurs within 24 hours to improve outcomes.
If the eye is too extensively damaged to be salvaged, non-functional, or causes persistent pain, enucleation may be necessary. This involves complete removal of the eyeball. Afterward, a prosthetic eye can be fitted for cosmetic rehabilitation. This decision is made after thorough evaluation of the eye’s condition and its potential for recovery.