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Open Globe Injuries

Introduction

Since the anterior diseases portion of open globe injuries has already been explored, this will primarily focus on the posterior portion.
- Due to lacerations from penetrating injuries, perforating injuries or intraocular foreign bodies, or can be due to rupture
- Ruptures are caused by high blunt trauma causing globe compression and extreme IOP. This can tear the eyewall, causing tissue prolapse, such as at limbus, EOM insertion, previous surgery

Lacerations are caused by sharp objects or projectiles. Prognosis depends on mechanism of injury, and extent of injury (penetrating, perforating, intraocular)
- Identified via Seidel's test, which identifies the presence of aqueous leakage
- Can be helpful in localising the site of leakage or damage, and whether or not a laceration is sealed or not.
- Application of fluorescein to the eye, and observing waterfall of non-fluorescent fluid following dilution from intraocular aqueous.

Intraocular Foreign Bodies represent a large portion of penetrating injuries (17-40%)
- >50% affect the posterior segment, and can affect any structure
- The type of foreign body can affect risk of complications and prognosis
- The preferred imaging modality is the CT scan, since other instruments may apply too much pressure on the eye.

Dead Giveaways

Ocular Hypotony:

  • IOP where eye is unable to maintain normal shape or function (~5-6 mmHg), due to loss of aqueous humour

  • Can be due to post-glaucoma surgery and open globe injuries

  • Leads to papilloedema, choroidal detachment and effusion and hypotony maculopathy

    Low IOP causes ICP to push forwards, leading to papilloedema.
    Low IOP causes ICP to push forwards, leading to papilloedema.
    Choroidal Effusion as visualised on ultrasound, shows the choroid detaching, causing the retina to collapse inwards, slightly similar to ROP.
    Choroidal Effusion as visualised on ultrasound, shows the choroid detaching, causing the retina to collapse inwards, slightly similar to ROP.
    Choroidal effusion pushes inwards. This image is due to scleritis, and not trauma, but appearance is similar.
    Choroidal effusion pushes inwards. This image is due to scleritis, and not trauma, but appearance is similar.
    Loss of structural support with scleral wall collapse in hypotony maculopathy causes chorioretinal folds, radiating from discs and macula. Associated with disc swelling, vessel tortuosity, distortion of central vision and relative hyperopia
    Loss of structural support with scleral wall collapse in hypotony maculopathy causes chorioretinal folds, radiating from discs and macula. Associated with disc swelling, vessel tortuosity, distortion of central vision and relative hyperopia
    From Retina Today. Shows the folding of the retina
    From Retina Today. Shows the folding of the retina

Phthisis Bulbi:

  • Describes an end-stage response to severe ocular insults

  • Atrophy, shrinkage and disorganisation of the globe and contents. Disrupted blood-ocular barrier and intraocular inflammation

    Anterior appearance of phthisis bulbi
    Anterior appearance of phthisis bulbi
    Becomes collapsed, shrinking and disfunctional, whilst also being opaque. Can cause iris neovascularisation, cataract, glaucoma, detachments and calcification of eye (abnormal bone tissue formation)
    Becomes collapsed, shrinking and disfunctional, whilst also being opaque. Can cause iris neovascularisation, cataract, glaucoma, detachments and calcification of eye (abnormal bone tissue formation)

Exogenous Endophthalmitis

  • Due to intraocular surgery, intravitreal injection

  • Can spread from adjacent tissue

  • Can be due to open-globe trauma

  • Entry of microorganisms into the eye, leading to intraocular infections which are much more difficult to treat, and more vision threatening.

    Anterior appearance
    Anterior appearance

Sympathetic Ophthalmia

  • Bilateral granulomatous panuveitis

  • Most commonly after open-globe injuries, from weeks up to years after trauma

  • Associated with:

    • Granulomatous anterior uveitis

    • Vitritis, choroiditis and papillitis

    • Sub-RPE nodules (Dalen-Fuch nodules)

    • Exudative retinal detachment

  • The exciting eye is typically removed, but if the sympathising eye follows, visual prognosis is very poor

    Panuveitis and snowbanking
    Panuveitis and snowbanking

Toxicity:

  • Iron is the most common foreign body, leading to siderosis

    • Anterior capsular cataract

    • Secondary glaucoma

    • Pigmentary retinopathy

      Pigmentary retinopathy from siderosis
      Pigmentary retinopathy from siderosis

    • Heterochromia irides

      Heterochromia irides
      Heterochromia irides

  • Copper can also occur

    • Endophthalmitis if copper content >85%

    • Chalcosis if copper content <85%

      • Kayser-Fleischer ring

      • Sunflower cataracts

      • Retinal deposits


diagnostic features

Prognosis:

  • As touched on before, prognosis depends on mechanism of injury, location of injury and extent of injury.

  • It also depends on what kind of injury.

  • Injuries like sympathetic ophthalmia and exogenous endophthalmitis are emergencies.


Exogenous Endophthalmitis:

  • Delay in repair, retained intraocular FB and lens rupture increases risk

  • Symptoms include painful red eye

  • Corneal oedema, conjunctival injection, hypopyon, AC and vitreous flare.


Sympathetic Ophthalmia:

  • Presented with anterior conditions

  • Exciting eye must be treated immediately before sympathising eye is involved.

2025, made by Eric Qin. UNSW. SOVS

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