Globe rupture: Difference between revisions
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'''Open-globe injuries''' (also called '''globe rupture''', '''globe laceration''', '''globe penetration''', or '''globe perforation''') are full-thickness eye-wall wounds requiring urgent diagnosis and treatment.<ref name=":0">{{Citation |last=Blair |first=Kyle |title=Globe Rupture |date=2022 |url=http://www.ncbi.nlm.nih.gov/books/NBK551637/ |work=StatPearls |place=Treasure Island (FL) |publisher=StatPearls Publishing |pmid=31869101 |access-date=2022-10-14 |last2=Alhadi |first2=Sameir A. |last3=Czyz |first3=Craig N.}}</ref> |
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'''Globe rupture''' is a condition where the integrity of the outer membranes of the [[eye]] are disrupted by blunt or [[penetrating trauma]],<ref>{{EMedicine|article|798223|Globe Rupture}}</ref> usually resulting from a full-thickness injury to the [[cornea]] or [[sclera]]. It may also result from damage caused by chemicals such as strong acids ([[hydrochloric acid]], [[sulfuric acid]], etc.) or toxic chemicals such as [[lewisite]]. |
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== Classification == |
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==Causes== |
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In 1996 Kuhn et al. created the Birmingham eye trauma terminology (BETT) to standardize the language used to describe traumatic ocular injuries internationally.<ref>{{Cite web |last=Justin |first=Grant A. |date=2022-06-07 |title=Birmingham Eye Trauma Terminology (BETT) - EyeWiki |url=https://eyewiki.aao.org/Birmingham_Eye_Trauma_Terminology_(BETT) |access-date=2022-10-14 |website=eyewiki.aao.org}}</ref> The BETT schema classifies open globe injuries as a laceration or a rupture. A ruptured globe occurs when rapid intraocular pressure elevation secondary to blunt trauma results in eyewall failure.<ref name=":1">{{Cite web |last=Wang |first=Daniel |last2=Deobhakta |first2=Avnish |date=2020-08-01 |title=Open Globe Injury: Assessment and Preoperative Management |url=https://www.aao.org/eyenet/article/open-globe-injury |access-date=2022-10-14 |website=American Academy of Ophthalmology |language=en}}</ref> The rupture site may be at the point of impact but more commonly occurs at the weakest and thinnest areas of the sclera.<ref name=":3">{{Cite journal |last=Zhou |first=Yujia |last2=DiSclafani |first2=Mark |last3=Jeang |first3=Lauren |last4=Shah |first4=Ankit A |date=2022-08-10 |title=Open Globe Injuries: Review of Evaluation, Management, and Surgical Pearls |url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9379121/ |journal=Clinical Ophthalmology (Auckland, N.Z.) |volume=16 |pages=2545–2559 |doi=10.2147/OPTH.S372011 |issn=1177-5467 |pmc=9379121 |pmid=35983163}}</ref> Regions prone to rupture are the rectus muscle insertion points, optic nerve insertion point, limbus, and prior surgical sites.<ref name=":02">{{Citation |last=Blair |first=Kyle |title=Globe Rupture |date=2022 |url=http://www.ncbi.nlm.nih.gov/books/NBK551637/ |work=StatPearls |place=Treasure Island (FL) |publisher=StatPearls Publishing |pmid=31869101 |access-date=2022-10-14 |last2=Alhadi |first2=Sameir A. |last3=Czyz |first3=Craig N.}}</ref><ref name=":3" /> Globe lacerations occur when a sharp object or projectile contacts the eye causing a full-thickness wound at the point of contact. Globe lacerations are further sub-classified into penetrating or perforating injuries.<ref name=":1" /> Penetrating injuries result in a single, full-thickness entry wound. In contrast, perforating injuries produce two full-thickness wounds at the entry and exit sites of the projectile.<ref name=":1" /> A penetrating globe injury with a retained foreign object, called an intraocular foreign body, has a different prognosis than a simple penetrating trauma. Therefore intraocular foreign body injuries are considered a distinct type of ocular injury.<ref name=":3" /> |
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Open-globe injuries are also classified by the anatomic region or zone of injury: |
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During a globe rupture, the outer membranes of the eye are completely or partially compromised, and the [[vitreous humour|vitreous]] and/or [[aqueous humour]] drain through the site of the rupture, causing the eye to 'deflate'. |
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* Zone 1- injury involves the cornea and limbus. |
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* Zone 2- injury involves the anterior 5mm of the sclera. |
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* Zone 3- injury involves the sclera, more than 5mm posterior to the limbus.<ref name=":1" /> |
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==Diagnosis== |
==Diagnosis== |
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Revision as of 05:57, 22 October 2022
 | This article needs additional citations for verification. (November 2014) |
| Globe rupture | |
|---|---|
| Other names | Open globe |
| Specialty | Ophthalmology |
Open-globe injuries (also called globe rupture, globe laceration, globe penetration, or globe perforation) are full-thickness eye-wall wounds requiring urgent diagnosis and treatment.[1]
Classification
In 1996 Kuhn et al. created the Birmingham eye trauma terminology (BETT) to standardize the language used to describe traumatic ocular injuries internationally.[2] The BETT schema classifies open globe injuries as a laceration or a rupture. A ruptured globe occurs when rapid intraocular pressure elevation secondary to blunt trauma results in eyewall failure.[3] The rupture site may be at the point of impact but more commonly occurs at the weakest and thinnest areas of the sclera.[4] Regions prone to rupture are the rectus muscle insertion points, optic nerve insertion point, limbus, and prior surgical sites.[5][4] Globe lacerations occur when a sharp object or projectile contacts the eye causing a full-thickness wound at the point of contact. Globe lacerations are further sub-classified into penetrating or perforating injuries.[3] Penetrating injuries result in a single, full-thickness entry wound. In contrast, perforating injuries produce two full-thickness wounds at the entry and exit sites of the projectile.[3] A penetrating globe injury with a retained foreign object, called an intraocular foreign body, has a different prognosis than a simple penetrating trauma. Therefore intraocular foreign body injuries are considered a distinct type of ocular injury.[4]
Open-globe injuries are also classified by the anatomic region or zone of injury:
- Zone 1- injury involves the cornea and limbus.
- Zone 2- injury involves the anterior 5mm of the sclera.
- Zone 3- injury involves the sclera, more than 5mm posterior to the limbus.[3]
Diagnosis
On CT scan, signs of global rupture include: deepening of the anterior chamber, alteration of global contour with scleral folds, discontinuity of scleral folds, and a shrunken globe.[6]
Treatment
If not treated swiftly, severe damage can result. In many cases, globe ruptures are untreatable without enucleating the affected eye socket and replacing the eye with an ocular prosthesis. However, with modern diagnostic techniques, surgical approaches, and rehabilitation, in many cases eyes can be salvaged with retention of vision.
References
- ^ Blair, Kyle; Alhadi, Sameir A.; Czyz, Craig N. (2022), "Globe Rupture", StatPearls, Treasure Island (FL): StatPearls Publishing, PMID 31869101, retrieved 2022-10-14
- ^ Justin, Grant A. (2022-06-07). "Birmingham Eye Trauma Terminology (BETT) - EyeWiki". eyewiki.aao.org. Retrieved 2022-10-14.
- ^ a b c d Wang, Daniel; Deobhakta, Avnish (2020-08-01). "Open Globe Injury: Assessment and Preoperative Management". American Academy of Ophthalmology. Retrieved 2022-10-14.
- ^ a b c Zhou, Yujia; DiSclafani, Mark; Jeang, Lauren; Shah, Ankit A (2022-08-10). "Open Globe Injuries: Review of Evaluation, Management, and Surgical Pearls". Clinical Ophthalmology (Auckland, N.Z.). 16: 2545–2559. doi:10.2147/OPTH.S372011. ISSN 1177-5467. PMC 9379121. PMID 35983163.
{{cite journal}}: CS1 maint: unflagged free DOI (link) - ^ Blair, Kyle; Alhadi, Sameir A.; Czyz, Craig N. (2022), "Globe Rupture", StatPearls, Treasure Island (FL): StatPearls Publishing, PMID 31869101, retrieved 2022-10-14
- ^ Chronopoulos, Argyrios; Ong, Jong Min; Thumann, Gabriele; Schutz, James S. (September 2018). "Occult globe rupture: diagnostic and treatment challenge". Survey of Ophthalmology. 63 (5): 694–699. doi:10.1016/j.survophthal.2018.04.001. PMID 29649485. S2CID 4789937.
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