Globe Ruptures: Outcomes and Prognostic Analysis of Severe Ocular Trauma

Abstract

Purpose: Eye trauma is an important causes of monocular visual loss worldwide. This study aimed to describe the structural and functional characteristics and outcomes of 281 globe ruptures. Methods: Medical records of all patients undergoing surgery for a ruptured globe at Centro Hospitalar Universitário do Porto in the last 17 years were retrospectively reviewed. Results: Two hundred and eighty-one eyes of 277 patients were included. The majority of them were males (71%) with a mean age of 59.7±20.5. In 38.8% of the cases the cause was a fall. At the time of admission, 29.5% of the eyes had a visual acuity greater than 20/200 and 12.5% had no light perception. The median time between trauma and primary repair was less than 8h (interquartile range 5-12 h). A primary reconstruction was always attempted. Primary evisceration was performed in 14 cases (5%). In multivariable analysis, independent predictors of vision survival were male gender, shorter wound size and absence of vitreous hemorrhage. Conclusion: In this large, retrospective study on globe ruptures we identified male gender, short wound length, and the absence of vitreous hemorrhage or retinal detachment as predictors of improved functional outcome. We found a correlation between the presenting and final visual acuities and the Ocular Trauma Score. Our determination to reconstruct the traumatized eyes as early and as completely as possible was justified by the functional results: despite the severity of the injuries, one out of four eyes reached a final visual acuity greater than 20/200.

Mild-to-Moderate Traumatic Brain Injury: A Review with Focus on the Visual System

“…A serious eye trauma-related injury not to be overlooked is a ruptured globe. A ruptured globe or open globe injury is a full-thickness injury to the cornea, sclera or both of these components of the protective shell of the eyeball [143,144]. It can be caused by a blunt or penetrating force and exposes the fragile contents of the interior of the eye, which are easily perturbed [145].…”

“…The prognosis of ruptured globe depends heavily upon the size and severity of the rupture [143,144]. A small laceration to the cornea tends to have a better prognostic outcome than a deeper rupture, with a higher probability of vision recovery due to the cornea's location on the surface of the eye.…”