An eye globe rupture is a full-thickness wound to the eye wall, involving the cornea, the sclera, or both structures. This open-globe injury is a severe medical emergency that threatens vision. Immediate medical attention is necessary to maximize the chance of preserving the eye’s structure and function. The compromised outer layers allow for potential loss of internal contents and a high risk of infection.
Anatomy of an Eye Globe Rupture and Common Causes
The eye wall consists of the cornea, which is the clear front surface, and the sclera, which is the tough white layer surrounding the rest of the globe. A globe rupture occurs when a significant force causes a structural failure in these layers, creating a full-thickness defect. This damage is primarily caused by two distinct mechanisms: blunt trauma or penetrating trauma.
Blunt force trauma, such as an impact from a fist, a ball, or an object in a motor vehicle accident, is the most common cause of a true globe rupture. This impact rapidly compresses the eyeball, causing a sudden increase in internal fluid pressure. The eye wall then fails from the inside out at its weakest points, typically where the sclera is thinnest. These weak areas include the limbus (the border between the cornea and sclera) and the rectus muscle insertions (where the eye muscles attach).
Injuries caused by a sharp object, such as a knife or glass, are classified as lacerations, a different type of open-globe injury. Lacerations are full-thickness wounds caused by an external object cutting the eye wall from the outside in. The mechanism of injury influences the location and characteristics of the wound. Penetrating injuries have a single entry wound, while perforating injuries involve both an entrance and an exit wound.
Recognizing Symptoms and Immediate Response
Recognizing the specific signs of a globe rupture is paramount for a rapid and appropriate response. Patients typically experience sudden and severe eye pain, often accompanied by a profound and abrupt loss of vision. The appearance of the eye itself can provide direct evidence of the injury, even if the wound is partially hidden beneath the eyelid.
A specific sign is the extrusion of intraocular contents, where dark tissue, such as the iris or retina, may be visible protruding through the white of the eye or the cornea. The pupil may appear misshapen or irregular, sometimes taking on a “teardrop” shape if the iris has prolapsed into the wound. Blood pooling in the anterior chamber (hyphema) is a common finding, along with severe subconjunctival hemorrhage (extensive bleeding under the clear surface of the eye). The eye may also appear visibly deflated or soft due to the loss of internal fluid pressure.
An immediate response is necessary to prevent further damage before reaching medical care. The most important action is to avoid applying any pressure to the injured eye; the patient should not rub, press, or attempt to wash it. Any action that increases pressure can cause more internal contents to be lost through the wound.
If a foreign object is embedded in the eye, it must not be removed by anyone other than medical personnel. The best first-aid step is to lightly cover the eye with a rigid, protective shield that rests on the bony orbit, not on the eye itself. A simple household item, such as the bottom of a paper cup, can be modified and taped in place to serve this function until emergency services are reached. Patients should also avoid eating or drinking anything (NPO, nil per os) in preparation for potential emergency surgery.
Surgical Repair and Hospital Treatment
Once the patient arrives at the hospital, the initial focus is on confirming the extent of the injury and stabilizing the patient for surgery. Diagnostic imaging, typically a computed tomography (CT) scan, is necessary to accurately map the injury, rule out fractures of the bony orbit, and identify any retained intraocular foreign bodies. This imaging is performed with great care to avoid any pressure on the injured globe.
A major concern with an open globe injury is the risk of infection inside the eye, known as endophthalmitis. To prevent this complication, the patient is immediately given broad-spectrum intravenous antibiotics. Tetanus prophylaxis is also administered, depending on the patient’s vaccination history and the nature of the injury.
The primary goal of the first surgical procedure is to achieve a watertight closure of the corneal or scleral wound. This initial operation, called primary repair, focuses on restoring the structural integrity of the globe and repositioning any prolapsed tissue back inside the eye, if possible. The ophthalmologist uses fine sutures to meticulously close the defect, creating a sealed environment to protect internal structures. While this initial surgery is necessary for saving the eye’s anatomy, it does not necessarily restore full vision, which may require subsequent procedures.
Visual Outcomes and Long-Term Care
The final visual outcome following a globe rupture varies widely and depends on the severity and location of the initial injury. Injuries involving the posterior segment (the back of the eye where the retina and optic nerve are located) carry a poorer prognosis than those confined to the front of the eye. Poor vision at the time of initial examination often predicts a less favorable long-term result.
Many patients require multiple secondary surgeries after the initial primary repair to address issues like cataracts, retinal detachment, or scarring. Retinal detachment, where the light-sensing layer pulls away from the back of the eye, is a frequent and serious long-term complication. Other issues include chronic vision loss, the development of glaucoma, and in severe cases, the eye may shrink and become non-functional (phthisis bulbi). Long-term care involves close monitoring by an ophthalmologist and may include vision rehabilitation to maximize remaining visual function.