Management of the Ruptured Eye

Abstract

Rupture is the most severe form of mechanical globe trauma because of the tissue pathologies that occur at the time of injury and because of the post-injury destruction caused by scar formation as part of the body’s normal healing process. The diagnosis is usually straightforward because the wound is visible, often even to the naked eye. However, occult scleral ruptures – conjunctival integrity preserved – are not uncommon; any injury resulting from an impact by a large, blunt object therefore requires careful ocular evaluation. Due to the risk of expulsive choroidal haemorrhage wound closure is typically urgent, but all rules of proper wound toilette and suturing must be followed. The surgeon may elect to perform a staged approach, in which the initial wound-closure surgery is followed by intense topical corticosteroid therapy and then a second, comprehensive intraocular reconstruction a few days later, or to perform primary comprehensive surgery. All tissue pathologies must be properly addressed by an expert ocular traumatologist; in eyes with posterior scleral rupture, prophylactic chorioretinectomy should also be considered.