The annual incidence of open-globe injuries worldwide is estimated to be 203,000 cases. Overall, males comprise approximately 80 percent of open-globe injuries. Males age 10 to 30 are at greatest risk. The chance of blunt globe rupture also increases after some types of ocular surgical procedures, including: large incision cataract removal, cornea transplant, glaucoma filtering, or refractive surgery.
TERM | DEFINITION |
Open-globe injury | Full-thickness wound of eye wall |
Laceration | Full-thickness wound of the eye wall, caused by a sharp object |
Lamellar laceration | Partial thickness wound of the eye wall |
Rupture | Full-thickness wound of the eye wall, caused by a blunt object |
Penetrating injury | Only entrance wound is present |
Perforating injury | Both an entrance and exit wound are present |
2 Ferenc Kuhn, Robert Morris, Viktória Mester, C. Douglas Witherspoon, “Terminology of Mechanical Injuries: The Birmingham Eye Trauma Terminology,” in Ferenc Kuhn Ocular Traumatology (Springer-Verlag Berlin Heidelberg 2008), 3-12.
Reproduced with permission from: Andreoli CM, Gardiner MF. Open globe injuries: Emergent evaluation and initial management. In: UpToDate, Post TW (Ed), UpToDate, Waltham, MA. (Accessed on April 9 2014.) Copyright © 2014 UpToDate, Inc. For more information visit www.uptodate.com.
Based on Mass. Eye and Ear’s experience, we recommend that institutions adopt a standardized management protocol for treating open-globe injuries that consists of a dedicated eye trauma service and 48 hours of intravenous antibiotics.
Preferred Imaging Modality:
Axial and coronal CT of the eye without contrast, utilizing 1 to 2mm cuts through Note: Ocular CT has limited ability to demonstrate an occult open-globe injury and should not be used as the sole determining factor for decisions regarding surgical exploration. |
The standard Mass. Eye and Ear protocol for eye trauma has resulted in the lowest civilian endophthalmitis rates – less than 1% of cases – reported in the country.
The literature suggests that endophthalmitis rates around the world range from 2.6% to 17%. The United States National Eye Trauma Registry has reported an endophthalmitis rate of 6.9% after open-globe repair.3
3Andreoli CM, Andreoli MT, Kloek CE, Ahuero AE, Vavvas D, Durand ML. Low rate of endophthalmitis in a large series of open-globe injuries. Am J Ophthalmol 2009; 147(4): 601-608.