Open Globe Injuries: Review of Evaluation, Management, and Surgical Pearls

Abstract

Ocular trauma may either be closed globe or open globe. Open globe injuries are full-thickness defects of the eyewall and are often differentiated by the mechanisms of injury from which they are caused: sharp or blunt trauma. They are ocular emergencies and can lead to substantial visual morbidity. Without timely intervention, damage is irreversible and leads to permanent vision loss. The goals of evaluation are to identify the mechanism of injury, characterize the extent of injury, and gather relevant history. If an open globe is suspected, ophthalmologic consultation should be requested. Once an open globe is diagnosed, preparations for surgery should be made immediately and steps should be taken to avoid further injury. Intraocular infection risk is relatively high, requiring immediate empiric systemic antibiotics. Emergent surgical exploration and primary closure is indicated whenever possible. After initial closure, secondary surgery and revision may be needed to improve vision outcomes, followed by extensive follow-up. In this review, best practices for evaluation and management are reviewed, with particular focus on the surgical approach and techniques.

Study on Maintenance of Eyeball Morphology by Foldable Capsular Vitreous Body in Severe Ocular Trauma

“…Intraocular pressure is one of the important factors to maintain the homeostasis of the eye. Severe ocular trauma may result in damage to the iris and the ciliary body or loss of ocular contents due to a ruptured globe, affecting intraocular pressure [17] . In our research, we found the intraocular pressure of 91.8% of patients remained in the normal range after the operation.…”

Ophthalmic Trauma-Related Instruments—Critical Tools for Winning the Case

“…40,42 Given these drawbacks of cyanoacrylate glue, it should be reserved for cases when suturing fails to create a watertight wound, which is often encountered with stellate corneal wounds that have poor tissue apposition. 3,43 When applied, care should be taken to only apply glue to the laceration edges, and once polymerization is complete, a Seidel test should be performed to confirm adequate sealing. Finally, a soft BCL is applied in all cases of cyanoacrylate glue use to avoid irritation and decrease the chance of glue dislodgment.…”

“…Absorbable Vicryl sutures are sometimes used instead of Nylon in patients where suture removal without sedation is difficult, such as in children or individuals with intellectual disabilities. 3 Conjunctiva is most often closed with absorbable 8-0 Vicryl sutures. While in general, we do not advise repairing wounds that extend past the muscle insertions, for the rare open globe injuries that require removing and/or reattaching extraocular muscles, 6-0 Vicryl on a spatulated needle is most often used for muscle imbrication and reattachment.…”

“…While in general, we do not advise repairing wounds that extend past the muscle insertions, for the rare open globe injuries that require removing and/or reattaching extraocular muscles, 6-0 Vicryl on a spatulated needle is most often used for muscle imbrication and reattachment. Although a detailed review of open globe repair is beyond the scope of this review and can be found elsewhere, 3,4 the following general suturing principles apply. 10-0 sutures should be used for cornea, 9-0 sutures should be used for limbus, and 8-0 sutures should be used for sclera.…”

“…Although each case is different, approximation of the limbus is the first step for cases involving zone 1, as this helps to restore normal anatomy and position the 2 sides of the corneal wound in correct alignment, especially when there is significant disorganization from the injury. 3 After the limbus is aligned, close Zone 1, followed by Zone 3. Zone 1 wounds should be sequentially bisected with interrupted sutures, and suturing in the central visual axis should be avoided if possible.…”