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Globe rupture
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Globe rupture
Open-globe injuries (also called globe rupture, globe laceration, globe penetration, or globe perforation) are full-thickness eye-wall wounds requiring urgent diagnosis and treatment.
In 1996 Kuhn et al. created the Birmingham eye trauma terminology (BETT) to standardize the language used to describe traumatic ocular injuries internationally. The BETT schema classifies open globe injuries as a laceration or a rupture. A ruptured globe occurs when rapid intraocular pressure elevation secondary to blunt trauma results in eyewall failure. The rupture site may be at the point of impact but more commonly occurs at the weakest and thinnest areas of the sclera. Regions prone to rupture are the rectus muscle insertion points, optic nerve insertion point, limbus, and prior surgical sites. Globe lacerations occur when a sharp object or projectile contacts the eye causing a full-thickness wound at the point of contact. Globe lacerations are further sub-classified into penetrating or perforating injuries. Penetrating injuries result in a single, full-thickness entry wound. In contrast, perforating injuries produce two full-thickness wounds at the entry and exit sites of the projectile. A penetrating globe injury with a retained foreign object, called an intraocular foreign body, has a different prognosis than a simple penetrating trauma. Therefore, intraocular foreign body injuries are considered a distinct type of ocular injury.
Open-globe injuries are also classified by the anatomic region or zone of injury:
The eye wall is composed of three layers that lie flat against each other to form the eyeball. The external layer is a tough, white membrane called the sclera with a clear dome at the front of the eye called the cornea. The line where the sclera and cornea converge is known as the limbus. The middle layer consists of the colored part of the eye known as the iris, a muscular structure behind the iris responsible for focusing the lens known as the ciliary body, and a layer of blood vessels known as the choroid. The retina is the innermost layer of the eye. The retina contains nerve cells responsible for sensing light and sending visual information to the brain.
The eye can also be divided into three chambers:
There are an estimated 3.5 eye injuries per 100,000 people annually worldwide. The most frequently reported mechanism of injury was trauma by foreign objects (metal, sand, wood), shotgun injuries, motor vehicle accidents, and falls in the home. All mechanisms of injury were more prevalent in males except domestic falls, where a majority of patients were female. Males comprise 80% of open globe injuries, with men between 10 and 30 years of age at the most significant risk.
The mechanism and classification of open-globe injury may also vary by age. Penetrating eye lacerations due to pellet-gun, sport, motor vehicle, or fight-related injuries are more common in adolescent males. Whereas young men tend to sustain penetrating or perforating eye injuries at work, during an assault, or due to alcohol and drug-related accidents. Globe rupture is more common than eyewall lacerations in older patients, with ground-level falls the most common mechanism in those over 75 years of age.
Symptoms of an open-globe injury include eye pain, foreign body sensation, eye redness, and blurry or double vision. While globe injuries are commonly associated with peri-ocular trauma that may obstruct diagnosis, several signs suggest open-globe damage:
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Globe rupture
Open-globe injuries (also called globe rupture, globe laceration, globe penetration, or globe perforation) are full-thickness eye-wall wounds requiring urgent diagnosis and treatment.
In 1996 Kuhn et al. created the Birmingham eye trauma terminology (BETT) to standardize the language used to describe traumatic ocular injuries internationally. The BETT schema classifies open globe injuries as a laceration or a rupture. A ruptured globe occurs when rapid intraocular pressure elevation secondary to blunt trauma results in eyewall failure. The rupture site may be at the point of impact but more commonly occurs at the weakest and thinnest areas of the sclera. Regions prone to rupture are the rectus muscle insertion points, optic nerve insertion point, limbus, and prior surgical sites. Globe lacerations occur when a sharp object or projectile contacts the eye causing a full-thickness wound at the point of contact. Globe lacerations are further sub-classified into penetrating or perforating injuries. Penetrating injuries result in a single, full-thickness entry wound. In contrast, perforating injuries produce two full-thickness wounds at the entry and exit sites of the projectile. A penetrating globe injury with a retained foreign object, called an intraocular foreign body, has a different prognosis than a simple penetrating trauma. Therefore, intraocular foreign body injuries are considered a distinct type of ocular injury.
Open-globe injuries are also classified by the anatomic region or zone of injury:
The eye wall is composed of three layers that lie flat against each other to form the eyeball. The external layer is a tough, white membrane called the sclera with a clear dome at the front of the eye called the cornea. The line where the sclera and cornea converge is known as the limbus. The middle layer consists of the colored part of the eye known as the iris, a muscular structure behind the iris responsible for focusing the lens known as the ciliary body, and a layer of blood vessels known as the choroid. The retina is the innermost layer of the eye. The retina contains nerve cells responsible for sensing light and sending visual information to the brain.
The eye can also be divided into three chambers:
There are an estimated 3.5 eye injuries per 100,000 people annually worldwide. The most frequently reported mechanism of injury was trauma by foreign objects (metal, sand, wood), shotgun injuries, motor vehicle accidents, and falls in the home. All mechanisms of injury were more prevalent in males except domestic falls, where a majority of patients were female. Males comprise 80% of open globe injuries, with men between 10 and 30 years of age at the most significant risk.
The mechanism and classification of open-globe injury may also vary by age. Penetrating eye lacerations due to pellet-gun, sport, motor vehicle, or fight-related injuries are more common in adolescent males. Whereas young men tend to sustain penetrating or perforating eye injuries at work, during an assault, or due to alcohol and drug-related accidents. Globe rupture is more common than eyewall lacerations in older patients, with ground-level falls the most common mechanism in those over 75 years of age.
Symptoms of an open-globe injury include eye pain, foreign body sensation, eye redness, and blurry or double vision. While globe injuries are commonly associated with peri-ocular trauma that may obstruct diagnosis, several signs suggest open-globe damage: