What's the diagnosis? By Dr. Loran Hatch
A 45 yo male was an unrestrained driver who rear-ended a tractor trailor while he was traveling 40mph. Airbags deployed. He denies LOC and ambulated at the scene. On exam, he has right pupil irregularity with only light/dark perception. CT of head and facial bones are done. What's the diagnosis? Scroll down for answer.
Answer: Globe rupture
- Blunt or penetrating trauma causes sudden increase in intraocular pressure
- On exam patient may have decreased visual acuity, irregular or teardrop shaped pupil, afferent pupillary defect, hyphema, positive Seidel's sign (anterior chamber leaks fluorescein stain), lens dislocation, and, or, a subconjunctival hemorrhage
- When suspected : do not measure intraocular pressure, cover eye with protective shield, consult ophthalmology immediately
- Treatment includes broad spectrum antibiotics (eg. IV cefazolin + IV moxifloxacin or IV levofloxacin), analgesics, antiemetics (prevent increased IOP with vomiting), tetanus immunization
Walker RA, Adhikari S. "Eye Emergencies." Tintinalli’s Emergency Medicine: A Comprehensive Study Guide, 8eEds. Judith E. Tintinalli, et al. New York, NY: McGraw-Hill, 2016, pg 1568-69