Case Report: Detecting an Occult Open Globe Laceration with Pneumotonometry

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Image credit: Wikimedia Commons

Author: Conner Murphy, MSIV
Medical Student
Uniformed Services University School of Medicine

Additional Authors:
Ivan Yue, MSIV
Medical Student
Uniformed Services University School of Medicine
AAEM/RSA Publications and Social Media Committee

Melisa Walsh, MSIII
Medical Student
Uniformed Services University School of Medicine


David Supinski, DSc EMPA-C
Emergency Medicine PA
Fort Belvoir Community Hospital Emergency Department

Grigory Charny, MD MS FAAEM
Assistant Professor
Department of Military and Emergency Medicine, Uniformed Services University School of Medicine

Introduction
An open globe laceration is defined as a full-thickness penetration of the eye by a sharp object.[1] Observational studies suggest that male patients ages 10-19 are at highest risk for this type of injury due to types of sports they participate in, occupations, and involvement in physical altercations.[2,3] Obvious signs of trauma are not always apparent, and a negative Seidel’s test does not rule out an occult intraocular foreign body as the wound may temporarily seal itself if small enough.[4] Decreased visual acuity, chemosis, hypotony, and pain are often the only clues that the patient has an open globe injury.[5] Early diagnosis and evaluation by an ophthalmologist are crucial to preserving vision.[6] In this case report we present an atypical case of a 24-year-old male patient with penetrating eye trauma to his right eye that was not apparent on physical exam or computed tomography.

Board Review: Traumatic Globe Rupture

Image Credit: Flickr

Author: Sophia Johnson, DO
Shane Sergent, DO
Conemaugh Memorial Medical Center
Originally Published: Modern Resident October/November 2014

A 32-year-old male presents to the ED after being struck in the right eye with a ball during a friendly tennis match. He complains of discomfort in the right eye, decreased visual acuity and nausea secondary to pain. Physical exam reveals periorbital ecchymosis, an irregularly shaped pupil and a shallow anterior chamber.

Patients may present with globe rupture after blunt or penetrating injury.[1] They may complain of pain in the eye or decreased visual acuity.[1] Maintain a high index of suspicion in patients who have any injury that may have penetrated the cornea.[1] This includes projectile objects launched while mowing the lawn, weed whacking or working with metal.[1] Blunt trauma to the eyeball or trauma with objects that impact the ocular rim and create a seal around the orbit can cause a rapid peak in intraocular pressure that ultimately leads to globe rupture.[1]