Open globe injury.

1. Open Globe Injury
Ruck
• Moxifloxacin 400 mg PO/IV if not given
• Position supine with head elevated
Truck
• Detailed evaluation as possible per guidelines
• Initiate teleconsult with photos
• Ultrasound contraindicated for suspected open globe injury
• Tetanus prophylaxis as available (Tdap 0.5ml IM)
• Continue endophthalmitis prophylaxis
• Additional dose of moxifloxacin 400 mg PO/IV at 12 hrs
• Continue moxiflxacin 400 mg PO/IV q day x 5 days
• Add clindamycin 300mg IV every 8 hours if available*
• Maintain patient comfort and supine/head elevated
positioning
House
Guidelines for Evaluation of Suspected
Open Globe Injury
• Continue above treatments
• Rigid eye shield
• No altitude restrictions for open globe
Plane
Critical Items
History:
• Blast injury
• Metal on metal impact
• Blunt trauma to ocular region
Concurrent trauma
• Lid lacerations
• Penetrating periocular trauma
Physical Exam:
• Visual acuity
• Afferent pupillary defect
• Suspicious findings
• Peaked pupil
• Abnormal anterior chamber depth
• Hemorrhagic chemosis
• Eyelid edema
• Traumatic cataract
• Definitive findings:
• Obvious laceration/rupture
• Prolapsed ocular contents
Peaked pupil Occult rupture
Abnormal anterior
chamber depth
Hemorrhagic
chemosis
• Maintain high suspicion for open globe injury
• Rigid eye shield to prevent further damage
• Moxifloxacin 400mg PO/IV (endophthalmitis prophylaxis)
• Ondansetron
• 4-8mg PO
• 4mg IV over 2-5 min
• 4mg IM
• Pain control (ketamine approved)
• Activate evac (URGENT)
• Goal is surgery within 24 hours
Hypopyon
Cloudy
vitreous
behind lens
Red, inflamed
eye
Endophthalmitis
Endophthalmitis
• Infection inside the eye
• Rsk is increased with delayed wound closure and
in injuries in rural settings
• Increasing pain, decreased vision
• Red, angry eye, hypopyon, cloudy vitreous