An open globe injury refers to a full-thickness wound that penetrates the outer layers of the eye, specifically the cornea or the sclera. It represents one of the most severe forms of eye trauma and requires immediate medical attention.
Causes and Symptoms of an Open Globe Injury
Open globe injuries typically arise from two main categories of trauma. Penetrating trauma occurs when a sharp object, such as metal fragments, glass shards, knives, or even BB pellets, directly pierces the eye.
Blunt force trauma can also cause an open globe injury. A forceful impact, like a punch, a collision with a ball, or an accident involving an airbag deployment, can cause a sudden increase in pressure within the eye, leading to a rupture of the eyeball at its weakest points. Common rupture sites include areas near muscle attachments or previous surgical incisions.
Recognizing the symptoms of an open globe injury helps in seeking prompt care. Individuals may experience severe eye pain. Vision often becomes significantly blurry or is lost entirely in the affected eye.
A visible cut or tear on the eye’s surface, or a misshapen pupil, can also indicate such an injury. Sometimes, the iris, the colored part of the eye, might protrude through the wound, or the eye may appear flattened or deflated. Fluid leaking from the eye can also be a sign of a full-thickness wound.
Emergency Management and Diagnosis
Immediate actions are necessary when an open globe injury is suspected. The primary step is to seek emergency medical help without delay, by contacting emergency services or going to the nearest emergency room. While awaiting professional care, gently place a rigid shield, such as the bottom half of a paper cup, over the injured eye to protect it without applying any pressure.
Several actions should be avoided to prevent worsening the injury. Do not rub or press on the injured eye. Do not attempt to remove any object that may be stuck in the eye. Applying any ointments, drops, or medications to the eye should be avoided, as these can introduce infection or further damage. Do not give the person aspirin or ibuprofen, as these medications can increase bleeding.
Upon arrival at the emergency room, an ophthalmologist will perform a careful visual examination, taking care not to exert pressure on the eye. To confirm the diagnosis and check for any foreign objects lodged inside the eye, a computed tomography (CT) scan is typically performed. Magnetic resonance imaging (MRI) is generally avoided if a metallic foreign body is suspected, due to potential complications.
Surgical Treatment and Recovery
Surgical intervention is necessary for an open globe injury and is performed as quickly as possible, ideally within 24 hours of the injury. The goal of this surgery is to close the wound in the cornea or sclera, restoring the structural integrity of the eye. During this procedure, any foreign material present inside the eye is removed, and any prolapsed eye tissue may be reinserted or removed if too damaged.
Depending on the extent and complexity of the damage, multiple surgeries may be necessary in the future to address secondary issues or to further improve visual function. These subsequent procedures might involve addressing retinal issues or removing cataracts that develop as a result of the trauma.
Recovery after open globe surgery involves several steps. Patients are typically prescribed antibiotic eye drops or oral antibiotics to prevent infections inside the eye, known as endophthalmitis. Activity restrictions are usually put in place, advising against bending over, heavy lifting, or any activity that could increase pressure within the eye.
An eye shield is often worn to protect the healing eye from accidental bumps or pressure. Regular follow-up appointments with the ophthalmologist are necessary to monitor healing, manage complications, and assess visual recovery.
Potential Complications and Long-Term Outlook
Despite prompt surgical repair, open globe injuries can lead to several complications. Endophthalmitis, a severe infection inside the eye, can result in permanent vision loss or loss of the eye itself. Retinal detachment, where the light-sensitive tissue at the back of the eye pulls away from its supporting layers, is another potential outcome that can impair vision.
Traumatic cataracts, which involve clouding of the eye’s natural lens due to the injury, are also common. Glaucoma, a condition characterized by increased pressure inside the eye that can damage the optic nerve, may also develop. These complications often require additional medical or surgical interventions.
The long-term visual outlook after an open globe injury is highly variable and depends on several factors. The initial severity of the injury plays a role, as does the specific location of the wound on the eye. Whether structures, such as the retina, optic nerve, or macula, were damaged or spared during the trauma influences the final visual outcome. While some individuals may regain useful vision, others may experience permanent and substantial vision loss.