A ruptured globe is a serious ocular injury that requires prompt and appropriate treatment in order to minimize the risk of complications and preserve visual function. Here is a step-by-step guide for managing a ruptured globe:
- Evaluate the extent of the injury and assess for any foreign bodies or penetrating objects. Obtain a CT scan to evaluate the depth and location of the wound.
- Administer analgesia and antibiotics to prevent infection and control pain.
- Perform a periotomy to allow the release of pressure from the eye and to provide better access to the wound. This involves making a small incision in the conjunctiva and Tenon’s capsule.
- Isolate the extraocular muscles and any foreign bodies or penetrating objects that may be present in the wound.
- Remove any foreign bodies or penetrating objects that may be present in the wound.
- Reposition any displaced uveal tissue and reform the globe as needed.
- Use absorbable sutures such as 8-0 vicryl or 9-0 vicryl to close the wound. Sutures should be placed in a radial or mattress fashion, and any areas of thinning or irregularity in the sclera should be reinforced with additional sutures.
- Use a pressure patch or shield to immobilize the eye and prevent further trauma or pressure.
- Monitor the patient closely for signs of infection, inflammation, or other complications, and adjust treatment as needed.
In conclusion, managing a ruptured globe requires a coordinated and systematic approach to ensure the best possible outcome for the patient. Periotomy, muscle isolation, removal of foreign bodies, reforming the globe, closure of wounds, and reposition of uveal tissue are all important steps in the process. The use of absorbable sutures such as 8-0 vicryl or 9-0 vicryl can help to promote healing and reduce the risk of complications. Ophthalmologists should be prepared for the possibility of a ruptured globe and have a plan in place for how to manage it in order to provide the best possible care for their patients.