Globe rupture - Revision history

Rossdonaldson1: /* Evaluation */

2020-12-16T23:38:22Z

Evaluation

← Revisión anterior		Revisión del 23:38 16 dic 2020
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	==Evaluation==		==Evaluation==
			[[File:PMC3038515 IJO-59-131-g007.png\|thumb\|positive Seidel’s test.]]
	*Inspect lids, lashes, cornea, sclera, and pupils.		*Inspect lids, lashes, cornea, sclera, and pupils.
	*Evaluate for a relative afferent pupillary defect		*Evaluate for a relative afferent pupillary defect
	*Visual acuity		*Visual acuity
	*Do NOT perform tonometry for [[IOP]]		*Do NOT perform tonometry for [[IOP]]
			*Positive Seidel’s test is indicative of globe rupture

	===Work-Up===		===Work-Up===

Rossdonaldson1: /* Clinical Features */

2020-12-16T23:02:35Z

Clinical Features

← Revisión anterior		Revisión del 23:02 16 dic 2020
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	==Clinical Features==		==Clinical Features==
	[[File:PMC4219229 MEAJO-21-347-g002.png\|thumb\|Globe rupture with protruding uveal tissue.]]		[[File:PMC4219229 MEAJO-21-347-g002.png\|thumb\|Globe rupture with protruding uveal tissue.]]
			[[File:PMC5000536 JOVR-11-313-g006.png\|thumb\|Globe rupture with deep penetrating orbital wounds and extensive globe laceration.]]
	*[[Eye pain]]		*[[Eye pain]]
	*+/- [[vision loss\|decreased visual acuity]]		*+/- [[vision loss\|decreased visual acuity]]

Rossdonaldson1: /* Clinical Features */

2020-12-16T21:33:18Z

Clinical Features

← Revisión anterior		Revisión del 21:33 16 dic 2020
Línea 14:		Línea 14:

	==Clinical Features==		==Clinical Features==
			[[File:PMC4219229 MEAJO-21-347-g002.png\|thumb\|Globe rupture with protruding uveal tissue.]]
	*[[Eye pain]]		*[[Eye pain]]
	*+/- [[vision loss\|decreased visual acuity]]		*+/- [[vision loss\|decreased visual acuity]]

Rossdonaldson1: /* Background */

2020-12-16T21:19:09Z

Background

← Revisión anterior		Revisión del 21:19 16 dic 2020
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	==Background==		==Background==
			[[File:Schematic diagram of the human eye en.png\|thumb\|Eye anatomy.]]
	*Vision threatening emergency		*Vision threatening emergency
	*Is a full thickness disruption of sclera or cornea<ref>Layer N, et a. Algorithm for evaluation and management of the ruptured globe in an adult. Department of Ophthamology, University of California, San Francisco. http://www.icoph.org/dynamic/attachments/resources/rupturedglobeico.pdf</ref>		*Is a full thickness disruption of sclera or cornea<ref>Layer N, et a. Algorithm for evaluation and management of the ruptured globe in an adult. Department of Ophthamology, University of California, San Francisco. http://www.icoph.org/dynamic/attachments/resources/rupturedglobeico.pdf</ref>

Hour: /* AntibioticsLayer N, et a. Algorithm for evaluation and management of the ruptured globe in an adult. Department of Ophthamology, University of California, San Francisco. http://www.icoph.org/dynamic/attachments/resources/rupturedglobeico.pdf */

2020-03-04T03:51:15Z

AntibioticsLayer N, et a. Algorithm for evaluation and management of the ruptured globe in an adult. Department of Ophthamology, University of California, San Francisco. http://www.icoph.org/dynamic/attachments/resources/rupturedglobeico.pdf

← Revisión anterior		Revisión del 03:51 4 mar 2020
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	*[[Ceftazidime]] 1gm + [[vancomycin]] 1 gm		*[[Ceftazidime]] 1gm + [[vancomycin]] 1 gm
	*Penicillin allergy: [[Ciprofloxacin]] + [[vancomycin]]		*Penicillin allergy: [[Ciprofloxacin]] + [[vancomycin]]

			====Children====
			*For children < 12 years, cefazolin 25-50 mg/kg/day in three divided doses, and gentamicin 2 mg/kg iv q8h. Gentamicin peak and trough levels are obtained one-half hour before and after the fifth dose, and BUN/Cr levels are evaluated every other day.

	==Disposition==		==Disposition==

Hour: /* Slit-lamp */

2020-03-04T03:45:54Z

Slit-lamp

← Revisión anterior		Revisión del 03:45 4 mar 2020
Línea 22:		Línea 22:

	===[[Slit-lamp]]===		===[[Slit-lamp]]===
			*Once the diagnosis of a ruptured globe is made, further examination should be DEFERRED until the time of surgical repair in the operating room. Consider diagnosis via penlight exam. Slit lamp findings described below, but crucial to avoid any pressure on eye, which risks extrusion of intraocular contents.
	*Deep or shallow anterior chamber compared to fellow eye, full thickness scleral or corneal laceration, severe subconjunctival hemorrhage (especially involving 360 degrees of bulbar conjunctiva, often bulbous), peaked or irregular pupil, iris transillumination defect, lens material or vitreous in the AC, foreign body tract or new cataract in the lens, limitation of extraocular motility (greatest in the direction of rupture), intraocular contents may be outside of the globe		*Deep or shallow anterior chamber compared to fellow eye, full thickness scleral or corneal laceration, severe subconjunctival hemorrhage (especially involving 360 degrees of bulbar conjunctiva, often bulbous), peaked or irregular pupil, iris transillumination defect, lens material or vitreous in the AC, foreign body tract or new cataract in the lens, limitation of extraocular motility (greatest in the direction of rupture), intraocular contents may be outside of the globe
	*[[Hyphema]], periorbital ecchymosis, [[Lens dislocation]], traumatic optic neuropathy, choroidal rupture, dislocated/subluxed lens		*[[Hyphema]], periorbital ecchymosis, [[Lens dislocation]], traumatic optic neuropathy, choroidal rupture, dislocated/subluxed lens

Hour: /* Slit-lamp */

2020-03-04T03:42:30Z

Slit-lamp

← Revisión anterior		Revisión del 03:42 4 mar 2020
Línea 22:		Línea 22:

	===[[Slit-lamp]]===		===[[Slit-lamp]]===
	*~~Shallow~~ anterior chamber		*Deep or shallow anterior chamber compared to fellow eye, full thickness scleral or corneal laceration, severe subconjunctival hemorrhage (especially involving 360 degrees of bulbar conjunctiva, often bulbous), peaked or irregular pupil, iris transillumination defect, lens material or vitreous in the AC, foreign body tract or new cataract in the lens, limitation of extraocular motility (greatest in the direction of rupture), intraocular contents may be outside of the globe
	*[[Hyphema]]		*[[Hyphema]], periorbital ecchymosis, [[Lens dislocation]], traumatic optic neuropathy, choroidal rupture, dislocated/subluxed lens
	*Seidel's sign - do not perform this test if suspect open globe		*Seidel's sign - do not perform this test if suspect open globe
	**May be falsely negative if scleral rupture is small		**May be falsely negative if scleral rupture is small
	*[[Lens dislocation]]

	==Differential Diagnosis==		==Differential Diagnosis==

Alexgrohmann: /* Clinical Features */

2020-02-23T18:23:28Z

Clinical Features

← Revisión anterior		Revisión del 18:23 23 feb 2020
Línea 15:		Línea 15:
	*[[Eye pain]]		*[[Eye pain]]
	*+/- [[vision loss\|decreased visual acuity]]		*+/- [[vision loss\|decreased visual acuity]]
	*~~Tear~~-shaped pupil		*Teardrop-shaped pupil
			*Flat anterior chamber
	*Extrusion of intraocular content		*Extrusion of intraocular content
	*[[Subconjunctival hemorrhage]] involving entire sclera		*[[Subconjunctival hemorrhage]] involving entire (360 degree) sclera
	*[[red eye\|Hemorrhagic chemosis]]		*[[red eye\|Hemorrhagic chemosis]]

ClaireLewis at 16:47, 5 October 2019

2019-10-05T16:47:57Z

← Revisión anterior		Revisión del 16:47 5 oct 2019
Línea 18:		Línea 18:
	*Extrusion of intraocular content		*Extrusion of intraocular content
	*[[Subconjunctival hemorrhage]] involving entire sclera		*[[Subconjunctival hemorrhage]] involving entire sclera
	*Hemorrhagic chemosis		*[[red eye\|Hemorrhagic chemosis]]

	===Slit-lamp===		===[[Slit-lamp]]===
	*Shallow anterior chamber		*Shallow anterior chamber
	*[[Hyphema]]		*[[Hyphema]]
Línea 34:		Línea 34:
	*Evaluate for a relative afferent pupillary defect		*Evaluate for a relative afferent pupillary defect
	*Visual acuity		*Visual acuity
	*Do NOT perform tonometry for IOP		*Do NOT perform tonometry for [[IOP]]

	===Work-Up===		===Work-Up===
Línea 56:		Línea 56:

	===[[Antibiotics]]<ref>Layer N, et a. Algorithm for evaluation and management of the ruptured globe in an adult. Department of Ophthamology, University of California, San Francisco. http://www.icoph.org/dynamic/attachments/resources/rupturedglobeico.pdf</ref>===		===[[Antibiotics]]<ref>Layer N, et a. Algorithm for evaluation and management of the ruptured globe in an adult. Department of Ophthamology, University of California, San Francisco. http://www.icoph.org/dynamic/attachments/resources/rupturedglobeico.pdf</ref>===
	====NO intra-ocular foreign body====		====NO intra-[[ocular foreign body]]====
	*First choice: [[Fluoroquinolone]] IV, such as Levofloxacin '''OR'''		*First choice: [[Fluoroquinolone]] IV, such as Levofloxacin '''OR'''
	*Second choice: [[Vancomycin]] IV and [[ceftazidime]]		*Second choice: [[Vancomycin]] IV and [[ceftazidime]]

	====Intra-ocular foreign body PRESENT====		====Intra-[[ocular foreign body]] PRESENT====
	*[[Ceftazidime]] 1gm + [[vancomycin]] 1 gm		*[[Ceftazidime]] 1gm + [[vancomycin]] 1 gm
	*Penicillin allergy: [[Ciprofloxacin]] + [[vancomycin]]		*Penicillin allergy: [[Ciprofloxacin]] + [[vancomycin]]

ClaireLewis at 17:57, 28 September 2019

2019-09-28T17:57:06Z

← Revisión anterior		Revisión del 17:57 28 sep 2019
Línea 13:		Línea 13:

	==Clinical Features==		==Clinical Features==
	*Eye pain		*[[Eye pain]]
	*+/- decreased visual acuity		*+/- [[vision loss\|decreased visual acuity]]
	*Tear-shaped pupil		*Tear-shaped pupil
	*Extrusion of intraocular content		*Extrusion of intraocular content
	*Subconjunctival hemorrhage involving entire sclera		*[[Subconjunctival hemorrhage]] involving entire sclera
	*Hemorrhagic chemosis		*Hemorrhagic chemosis

	===Slit-lamp===		===Slit-lamp===
	*Shallow anterior chamber		*Shallow anterior chamber
	*Hyphema		*[[Hyphema]]
	*Seidel's sign - do not perform this test if suspect open globe		*Seidel's sign - do not perform this test if suspect open globe
	**May be falsely negative if scleral rupture is small		**May be falsely negative if scleral rupture is small
	*Lens dislocation		*[[Lens dislocation]]

	==Differential Diagnosis==		==Differential Diagnosis==
Línea 33:		Línea 33:
	*Inspect lids, lashes, cornea, sclera, and pupils.		*Inspect lids, lashes, cornea, sclera, and pupils.
	*Evaluate for a relative afferent pupillary defect		*Evaluate for a relative afferent pupillary defect
	*Visual ~~Acuity~~		*Visual acuity
	*Do NOT perform tonometry for IOP		*Do NOT perform tonometry for IOP

Línea 50:		Línea 50:
	**Elevate head of bed		**Elevate head of bed
	**Bed rest; no bending/lifting/Valsalva		**Bed rest; no bending/lifting/Valsalva
	**Consider ~~anti-emetic~~ (e.g. [[ondansteron]] 4mg IV)		**Consider [[antiemetics\|antiemetic]] (e.g. [[ondansteron]] 4mg IV)
	*IV pain medications PRN		*IV [[analgesia\|pain medications]] PRN
	*[[Tetanus prophylaxis]] (if indicated)		*[[Tetanus prophylaxis]] (if indicated)
	*If [[intubation]] necessary, use [[succinylcholine]] and [[ketamine]] <3mg/kg (do not increase intraocular pressure or cause adverse outcomes)<ref>Libonati MM, Leahy JJ, Ellison N: The use of succinylcholine in open eye surgery. Anesthesiology 1985; 62:637-640</ref>		*If [[intubation]] necessary, use [[succinylcholine]] and [[ketamine]] <3mg/kg (do not increase intraocular pressure or cause adverse outcomes)<ref>Libonati MM, Leahy JJ, Ellison N: The use of succinylcholine in open eye surgery. Anesthesiology 1985; 62:637-640</ref>