Question

How would you distinguish between open and closed globe injury?

Hint:

In any suspected open globe injury, immediate surgical consultation is required. Closed globe injuries may still require close monitoring for complications like retinal detachment or intraocular pressure changes.

Answer 1

Step 1: Distinguishing Open and Closed Globe Injury.
Open globe injuries involve a breach in the integrity of the ocular wall, while closed globe injuries do not. The distinction is important for both diagnosis and management. Key features that help differentiate open from closed globe injuries include:
(1) Clinical History:
- Open Globe Injury: Typically occurs due to high-energy trauma (e.g., sharp objects, projectiles) that penetrates the eye. The patient may report penetrating trauma or an object that has entered the eye.
- Closed Globe Injury: Often results from blunt trauma (e.g., a punch or ball). The history involves impact without an external object entering the eye.
(2) Physical Examination:
- Open Globe Injury: - Positive signs: A breach in the cornea or sclera, often visible as a laceration or penetrating wound. - Severe signs: The presence of aqueous leakage, hyphema, or protruding tissue (e.g., iris or lens). - Closed Globe Injury: - No breach in the globe: There are no lacerations or visible wounds in the cornea or sclera. However, signs like bruising (ecchymosis), subconjunctival hemorrhage, or irregular pupils may be present.
(3) Pupil Examination:
- Open Globe Injury: The pupil may be irregular or teardrop-shaped, indicative of an anterior chamber or iris injury. A positive Seidel test (aqueous leakage) can help confirm the diagnosis. - Closed Globe Injury: The pupil is typically round, though there may be signs of traumatic mydriasis or miosis depending on the injury.
(4) Imaging:
- Open Globe Injury: CT scan or ultrasound can be performed to evaluate the extent of globe rupture, foreign body presence, and any intraocular or orbital damage. - Closed Globe Injury: Imaging may show orbital fractures, orbital hemorrhage, or retinal hemorrhages, but no obvious globe rupture or penetration.