Echocardiography and electrocardiography can be used to determine cardiac function, and carotid artery ultrasonography to assess for stenosis.1, An erythrocyte sedimentation rate and C-reactive protein level should be obtained for patients older than 50 years with symptoms of fever, fatigue, jaw tenderness, scalp tenderness, and weight loss in whom giant cell arteritis is suspected. Otherwise, closure of the open globe is done primarily focusing on anterior segment structures, with all attempts made to restore the eye back to its pre-trauma state. No matter the condition of the globe, always close the globe (if possible). Antiemetics should be administered to prevent emesis. http://creativecommons.org/licenses/by-nc/3.0/. Open globe injuries: factors predictive of poor outcome. INDICATIONS: This is a XX-year-old (wo)man with a ruptured globe of the XXX eye. Coleman DJ. Omar Barrada, MD. Alkali burns are more common because of the prevalence of alkali in household cleaning agents and are more harmful than acid burns because alkali agents penetrate the ocular surface more quickly.19,20. Negrel AD, Thylefors B. Of these eyes with RD, 27% detached within 24 hours of primary open globe repair, 47% detached within 1 week, and 72% detached within 1 month. Although you may feel compelled to give patients hope for complete visual recovery, it is important to let patients know that it is difficult to accurately prognosticate their clinical outcome. Use the teach-back method to ensure the patient understands. During a rest break, the guide reminded everyone to drink lots of fluid and to eat a snack to maintain energy and avoid dehydration. These antibiotics are to prevent endophthalmitis and other infections. It usually takes at least two weeks for your eye to heal, but youll have to continue protecting it for several weeks after that. Importantly, the initial surgery for globe rupture is primarily just to close the eye so that it can begin the healing process. Globe Jang SY, Lee SY, Yoon JS. Her postoperative course was complicated by hyphema rebleed, total RD, retinal incarceration, and PVR. Penetrating or perforating ocular injuries can be due to injury from any sharp or high velocity object. Most patients have a final visual acuity of 20/400 or worse.17 Follow-up should include screening for cerebrovascular complications. It is tempting to remove the lens material in the setting of a violated lens capsule. The recovery time for a ruptured Achilles can take from four to six months, ruling him out for at least the rest of the regular season. OTS was 16. Pharmacologic pupillary dilation and intraocular pressure measurement are not recommended. Patients with a chemical eye injury commonly present with eye pain, redness, tearing, sensitivity to light, and decreased vision. If possible, be kind to the cornea. Be careful when prepping and dressing the eye for surgery. Consider using topical moxifloxacin for surgical prep for open globes since this is common in many practice situations. The role and timing of pars plana vitrec-tomy in penetrating ocular trauma. Agrawal R, Rao G, Naigaonkar R, Ou X, Desai S. Prognostic factors for vision outcome after surgical repair of open globe injuries. Patients experiencing open globe injuries are likely having one of the worst days of their lives. By far the most predictive prognostic factor is the initial visual acuity on presentation, as well as injury to zone III, history of corneal transplantation, presence of RAPD, time from injury, and presence of retinal detachment and/or vitreous hemorrhage, and crystalline lens dislocation[17][18]. However, the injury may be more extensive than originally thought and the repair can become more tedious and difficult with a poorly cooperative patient. Copyright 2023 American Academy of Family Physicians. Ultrasonography, if possible without causing further damage to the eye, is helpful when the media preclude a posterior exam, and has been shown to have a 100% positive predictive value for diagnosing retinal detachment and IOFB[7]. Ahn JM, Lee SY, Yoon JS. The physician should identify the type of chemical involved and the amount that came in contact with the eye to evaluate for severity of the injury. de Bustros S, Michels RG, Glaser BM. These symptoms may be attributed to a posterior vitreous detachment; however, 14% of patients develop a retinal tear.11 Visual acuity may be unaffected with a retinal tear, but confrontational visual field testing may detect a peripheral visual field defect. Miller SC, et al. He presented with an RAPD in the affected eye, total hyphema, 360-degree subconjunctival hemorrhage, and subluxation of the natural lens. However, it is essential to gain control early on in the case with strategically placed sutures to close the eye first. The presence of an afferent pupillary defect or posterior wound location indicates poor vision outcomes. 24 Follow-up after a globe injury should include monitoring for sympathetic ophthalmia (i.e., intraocular inflammation in the contralateral eye), which, although rare, may lead to profound vision loss. Take care not to extrude intraocular contents by pressing on the eye or inducing valsalva in the patient. The sooner a ruptured globe is repaired, the higher the chance that there will be Endophthalmitis after open globe injury can be devastating to vision recovery. Surgical repair of the globe injury and removal of intraocular foreign bodies reduce the risk of endophthalmitis when surgery is performed within 24 hours of the injury.10 Therefore, patients with suspected globe injury should be referred immediately to an ophthalmologist. Chemical eye injuries occur when the ocular surface is exposed to an acid or alkali in the form of a liquid, powder, or gas. 2014 Apr;28(4):381-5. If the detachment is large enough to involve the macula, the patient may have a significant decline in vision. 2002 Jun;15(2):163-5. Unlike corneal wounds, scleral wounds may be hidden beneath the conjunctiva and Tenons capsule and may be obscured by clot or scarred-down Tenons. In the elderly, globe rupture is actually more common typically from falls and structural weakening of the eye with age[3]. 2018 May;96(3):e361-e365. Outcomes included follow-up best-corrected visual acuity at 6 months, 1 year, and final follow-up. If untreated, a retinal detachment may occur, causing a visual field defect in the peripheral vision that enlarges over the next few days. Any full-thickness injury to the She presented with a traumatic cataract, VH, and choroidal detachment. The injury is further classified based on three zones: I, II, and III. The idea of potentially losing an eye via enucleation or evisceration is devastating and difficult to come to terms with, and patients need time to adjust to such a situation. They may need to stay in intensive care for Enucleation for open globe injury. The OTS is also a useful tool to get an idea of visual recovery potential. Following a peritomy, careful dissection with Westcott scissors and curved Stephens scissors in the four oblique quadrants should be used to identify any scleral defect. STAMPEDERS HENRY SAYS HE RUPTURED HIS ACHILLES 2023-06-26T07:00:00.0000000Z. Similar results were reported in both studies by Feng et al: all patients received PPV, with visual recovery rates of 54.5% and 66.7%.15,23 Likewise, all 18 patients in a prospective interventional case series underwent vitrectomy, 16 of whom improved to at least light perception.18 Six eyes (33%) in that study achieved 20/200 or better final VA. Soni et al observed that 14 of 15 receiving PPV after primary open globe repair recovered to light perception or better.16 Similar to our study, eyes that underwent PPV compared with eyes without vitreoretinal intervention were significantly more likely to achieve visual recovery (odds ratio 256.7; 95% confidence interval 24.82,659.3).16 Salehi-Had et al reported that all eyes without vitreoretinal intervention remained NLP or experienced phthisis within 7 months, whereas five of the eight patients (62.5%) who had vitreoretinal surgery experienced improved vision ranging from HM to 20/70.6 However, the argument can be made that vitreoretinal surgery following primary open globe repair is reserved only for eyes clinically deemed to have visual potential, while eyes with anticipated final NLP are observed or undergo secondary enucleation. sharing sensitive information, make sure youre on a federal WebPediatric ocular trauma is any injury to a child's eye. After the repair, we administer subconjunctival antibiotics and steroids, and post-operatively, we administer one week of topical antibiotic eye drops and extended use of cycloplegics until intraocular inflammation subsides. Ophthalmology. Posterior examination revealed VH and RD. When one of these objects becomes lodged in the eye, it is referred to as an intraocular foreign body (IOFB), which occurs in up to 40% of ocular penetrating or perforating injuries. Acta Ophthalmol. Depending on the material causing the injury and location of entry, severe vision loss can occur. The patient should be instructed to prevent Valsalva maneuvers, including coughing or straining, and avoid placing external pressure on the eye to prevent extrusion of intraocular contents. The purpose of this study was to analyze eyes presenting with no light perception (NLP) after open globe injury (OGI) to determine visual outcomes and prognostic indicators for visual recovery. A dilated funduscopic examination can identify a retinal detachment. The patient should be made NPO immediately in preparation for emergent surgery. Ophthalmology. A retrospective review of medical records was performed on patients with OGI and initial NLP vision who presented to Yale-New Haven Hospital between January 1, 2003 and December 31, 2013. Typically, vancomycin and a third-generation cephalosporin such as ceftazidime are used. Controversies in the Management of Open-Globe Injuries Involving the Posterior Segment. Twenty-one patients (84%) remained with NLP or had a prosthesis at final follow-up, while four patients improved to light perception or hand motion (HM, Table 2). When direct visualization is not possible, gentle ultrasound and computed tomography should be used to evaluate the globe. Microbiologic trends and biofilm growth on explanted periorbital biomaterials: a 30-year review. Several studies have also variously described the toll of enucleation, which can have profound psychological as well as physical consequences.3537 Reports in the literature show that a significant proportion of anophthalmic patients can experience depression, anxiety, or stress compared with the normal population, and may also report lower health-related quality of life.3840 Moreover, chronic pain due to diverse causes ranging from dryness to infection and inflammation, such as in giant papillary conjunctivitis, has been associated with prosthetic eyes.4144 Phantom eye pain, estimated to occur in up to as many as 28% of anophthalmic patients, is a particularly challenging form of chronic pain, and permanent pain relief is often reported to occur in less than 10% of all patients.36,45,46.
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